Envision Healthcare has notched a win in its ongoing out-of-network reimbursement dispute with UnitedHealth Group, the physician staffing company announced Tuesday.
The U.S. District Court for the Southern District of Florida ruled in favor of Nashville, Tennessee-based Envision Healthcare's claims that UnitedHealth Group violated a contract with the physician staffing company by “unilaterally” reducing reimbursements and refusing to accept its physicians into insurance networks, and ordered the insurer to pay $91.2 million. The court issued the decision on March 30.
Envision expects to receive additional payment in prejudgment interest and court costs, according to the news release. The private equity backed-company is engaged in three other lawsuits against UnitedHealth, which likewise allege the insurance company shortchanged its clinicians. Envision, owned by KKR & Co., did not immediately respond to an interview request.
UnitedHealth disagrees with the court’s decision, a spokesperson wrote in an email. “We’ll continue efforts to protect our members and customers from the small number of bad actors—often private equity-backed physician staffing companies like Envision—who demand unreasonable and uncompetitive rates for their services and drive up the cost of care for everyone,” 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 clinicians at 780 hospitals and 250 ambulatory centers. A Yale University analysis of UnitedHealth claims data showed that when Envision took over emergency department operations, 62% of patients received out-of-network bills and rates skyrocketed.
UnitedHealth and Envision filed dueling lawsuits in U.S. District Court for the Middle District of Tennessee last year. UnitedHealth asserts it overpaid Envision, while Envision alleges the insurer improperly withheld payments.
Moody’s Investors Service downgraded Envision Healthcare’s debt to the lowest possible junk rating last year. According to the credit ratings service, Envision is likely go bankrupt because of the federal No Surprise Act, which prohibits many types of out-of-network bills, as well as its disputes with UnitedHealth.
