UnitedHealth lawsuit: Imagine Healthcare to receive $91M

Envision Healthcare has won its ongoing out-of-network reimbursement dispute against UnitedHealth Group, the physician staffing company announced Tuesday.

The US District Court for the Southern District of Florida ruled in favor of Nashville, Tennessee Imagine Healthcare Claims that UnitedHealth Group violated a contract with the physician staffing company by “unilaterally” reducing reimbursement and refusing to accept its physicians into the insurance network, and ordered the insurer to pay $91.2 million. The court issued the decision on March 30, announced Kalpana via news release on Tuesday.

According to the news release, Kalpana is expected to receive additional payments in pre-judgment interest and court costs. The private equity-backed company is engaged in three other lawsuits against UnitedHealth alleging the insurer defrauded its physicians. KKR & Co-owned Kalpana did not immediately respond to an interview request.

UnitedHealth disagrees with the court’s decision, a spokesperson wrote in an email. “We will continue our efforts to protect our members and clients from a small number of bad actors – often private equity-backed physician staffing companies like Envision – who demand unfair and uncompetitive rates for their services and drive up the cost of care for all enhance,” the spokesperson wrote.

In 2018, KKR & Co. paid $10 billion in cash to acquire Envision, which is now one of the largest emergency department staffing, billing and collections companies with more than 25,000 physicians across 780 hospitals and 250 ambulance centers. A Yale University analysis of claims data from UnitedHealth found that When Kalpana took over Emergency department operations, 62% of patients received out-of-network bills, and rates skyrocketed.

UnitedHealth and Vision filed a duel lawsuit last year in the US District Court for the Middle District of Tennessee. UnitedHealth insisted it overpaid Envision, while Envision alleged that the insurer improperly withheld payment.

Moody’s Investors Service last year downgraded Envision Healthcare’s debt to its lowest possible junk rating. According to credit rating service, Envision likely to go bankrupt Due to the federal No Surprises Act, which prohibits many types of out-of-network bills, and its disputes with UnitedHealth.

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