UnitedHealth accused of illegally deflating reimbursements

Two hospital-based physician groups have filed a lawsuit accusing UnitedHealth Group of improperly cutting reimbursements to out-of-network providers, according to Law360

In a complaint filed Sept. 15, Emergency Care Services of Pennsylvania and Emergency Physician Associates of Pennsylvania allege UnitedHealth hired a data analysis firm to develop market-based reimbursement rates. However, the plaintiffs allege the tool used to come up with the rates, called Data iSight, doesn't use information about services or rates in local markets. 

"It does not use the local information it purports to, and exists simply to paper over the naked, unexcused, and illicit greed of the United defendants, whose growth in profit comes at the direct expense of front-line emergency room physicians," states the complaint. 

The plaintiffs allege UnitedHealth paid them between 75 percent and 90 percent of billed value for out-of-network claims for years. After implementing Data iSight, the reimbursement rate allegedly dropped to between 15 percent and 20 percent of billed value for claims. 

The complaint includes several claims, including breach of implied contract and civil conspiracy, according to Law360

Counsel information for UnitedHealth wasn't immediately available, according to the report. The case is pending in the Court of Common Pleas of Philadelphia County. 

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