UnitedHealthcare Sued Over Physician Contract Terminations

Two Connecticut medical associations have filed a suit against UnitedHealthcare challenging the insurer's termination of more than 2,000 physicians as participating providers in United's Medicare Advantage Networks.

The suit, filed by the Fairfield County Medical Association and The Hartford County Medical Association, alleges United's actions violate Medicare regulations as well as United's agreements with providers, according to an FCMA news release.

The lawsuit also claims the contract terminations will have an adverse affect on patients, who "may be forced to change and to reluctantly go elsewhere for medical care, which is particularly difficult for the elderly and/or disabled. There will likely also be patients so discouraged by United's changes that they may even be unwilling to seek covered preventative care. This will shift the geriatric population to a crisis-oriented culture which further impacts the health and safety of Medicare beneficiaries and increases the cost of their healthcare, a situation that the [Patient Protection and] Affordable Care Act was meant to address."

The terminations are set to take effect in February 2014. Of the 2,250 physicians who will be removed from the network across the state, 810 are primary care physicians and 1,440 are specialists, according to a HCMA news release.

According to HCMA, United decided to make the cuts due to CMS' Five-Star Rating Program of health plans. Because a plan's rating helps determine the reimbursement rate from CMS, the contract terminations are seen by HCMA as a move to increase United's profitability.

A statement from United explained the restructuring as a move to improve care: "We are focusing our Medicare Advantage network around the needs of our members to encourage higher quality healthcare coverage and help keep that coverage affordable. We will respond to the society's filing at the appropriate time," according to a report in The Hartford Current.

The case has caught the attention of Connecticut lawmakers, and several state Congressional members have asked United for more information about the network cuts, according to the Current.

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