Natural State News

A health insurer was routinely underpaying emergency room doctors, a federal jury ruled in Arkansas on Aug. 19, and now must pay close to $13 million to doctors and their attorneys.

The six-person jury said that Centene Corp. and its affiliates are liable for $9.4 million in underpayments to frontline emergency physicians, according to a press release issued by the plaintiff, TeamHealth. The award was for the complete amount sought by TeamHealth.

The actual figure, once legal costs and interest are added, will be closer to $13 million, the release stated.

Dr. Stan Thompson of Southeast Emergency Physicians | Photo courtesy of TeamHealth

Steven M. Cady of Williams & Connolly LLP, a Washington, D.C., law firm that represented the Centene and affiliates, says that the group does not accept the court ruling and does not intend to end its contract with TeamHealth.

“We disagree that [Centene affiliate] NovaSys breached the contract, and we plan to appeal,” Cady told Natural State News. “All of the health insurance claims at issue have already been paid at the appropriate rate for ACA (Affordable Healthcare Act) claims.”

The jurors were told that the Centene-controlled insurance companies and health networks struck a deal in 2014 to pay emergency room doctors 75% of regular commercial insurance billing rates. But they were only being paid 10%, according to court testimony, and it was difficult for them to obtain even that money.

John Zavitsanos, TeamHealth’s lead attorney in the case and a name partner with Houston-based Ahmad, Zavitsanos, Anaipakos, Alavi & Mensing P.C. (AZA), said the insurance companies did not merely cross the line — they bounded over it.

“The Centene defendants ignored their written agreements and tried to cheat these hardworking emergency room doctors,” Zavitsanos said in the press release. “They treated commercial insurance claims like Medicare payments; they tried to hide which company owed the money, they paid late. Their cavalier attitude toward these essential workers was abominable.”

The jury was told that while Centene and its Arkansas networks made reduced payments, they reported record profits of $1.2 billion in the second quarter of 2020. 

On its website, TeamHealth describes itself as “a physician-led, patient-focused company founded by doctors, for doctors.”

TeamHealth LifePoint Group Chief Clinical Officer Dr. Stan Thompson of Southeast Emergency Physicians said he would like to see the insurance company and the doctors move forward together.

“As emergency room clinicians, we treat every patient regardless of their ability to pay,” Thompson said in the release. “Many can’t pay and we depend on commercial plans like Centene’s to pay fair rates to cover the cost of the emergency department safety net. If all commercial plans pay at the level Centene tries to pay, I will not be able to recruit a single qualified emergency room physician to practice in Arkansas.

“After three years of pursuing Centene for underpayment, it is a relief to finally have a jury hear our case and vindicate our position that Centene, and not the patient, is responsible for fair payment for emergency services,” he continued. “My hope is that Centene, Ambetter and Novasys will now honor the court-approved rates so that their members can have peace of mind when they need emergency care during the pandemic and beyond.”

TeamHealth CEO Leif Murphy praised the doctors for their service in hazardous, potentially deadly situations.

“Today’s ruling is a win for frontline providers heroically risking their lives treating patients during the deadly COVID-19 pandemic,” Murphy said. “Centene’s actions are all too common on the part of payors. Large and profitable health insurance companies are using their market power to systematically underpay doctors, cancel contracts and further boost their record profits. Even in the face of extortive, punitive and collusive pricing behavior by health insurers, TeamHealth has remained committed to keeping patients out of the middle of billing disputes.”

This case is not unique. TeamHealth and its affiliates have filed more than 25 lawsuits in several states, alleging insurers are underpaying ER doctors.

A racketeering case against UnitedHealthcare filed in Nevada can move forward, a Clark County district court ruled in June. TeamHealth said UnitedHealthcare underpaid claims and schemed with Data iSight, a third-party claim administrator, to lower repayment rates.

“TeamHealth is confident that the court system will continue to rule against health insurance companies that engage in serial underpayment,” Murphy said. “While TeamHealth’s primary goal in every case is to obtain in-network contracts at reasonable rates as soon as possible, we are prepared to take cases to trial as we are confident that our position will be vindicated by a jury.”

In addition to lawsuits, TeamHealth is using the new Independent Dispute Resolution (IDR) systems to settle disputes, filing more than 10,000 claims and being awarded far greater payments — an average of 250% over the original amount.