Becker's Hospital Review

10 CFO / FINANCE UnitedHealthcare squeezes competition like a 'boa constrictor,' anesthesia group alleges in lawsuit By Ayla Ellison A large group of anesthesiologists is suing UnitedHealthcare in Colorado and Texas, alleging the health insur- ance giant is suppressing competition by forc- ing physicians out of its network and pushing hospitals to stop referring patients to them, according to e New York Times. e lawsuits were filed March 31 by U.S. An- esthesia Partners, a physician-owned group that operates in nine states. In Texas, the anesthesiologists claim the com- pany uses "pressure campaigns" and bribes surgeons by paying them more if they steer patients away from U.S. Anesthesia Partners. e lawsuit filed in Colorado alleges United- Healthcare stifles competition and squeez- es the practice from every angle "like a boa constrictor." e lawsuit further alleges Unit- edHealthcare orchestrated a "group boycott," according to the Times. UnitedHealthcare denies the allegations. In a statement to the Times, the company said the lawsuits are "the latest example of the group's efforts to pressure us into agreeing to its rate demands and to distract from the real reason that it no longer participates in our network." e company said U.S. Anesthesia Partners and many other physician groups backed by private equity investors drive up the cost of care by demanding "to be paid double or even triple the median rate we pay other phy- sicians providing the same services." UnitedHealthcare also said it's standard prac- tice for insurers to encourage the use of phy- sicians and hospitals within their networks, according to the Times. e physicians further allege there are con- flicts of interest because UnitedHealth Group, the parent company of UnitedHealthcare, also offers medical services and competes with U.S. Anesthesia Partners. U.S. Anesthe- sia Partners alleges a medical practice that UnitedHealth has ownership interest in tried to recruit its physicians and encouraged them to challenge the noncompete clauses in their contracts, according to the Times. "United and its affiliates have extended their tentacles into virtually every aspect of health- care, allowing United to squeeze, choke and crush any market participant that stands in the way of United's increased profits," the physi- cians claim, according to the Times. n Lawyers want $184M slice of Sutter antitrust settlement By Ayla Ellison T he California Attorney General's Office and five law firms that sued Sacramento, Calif.-based Sutter Health alleging antitrust violations are seeking 32 percent, or $184 million, of the $575 mil- lion settlement that would end the litigation, accord- ing to Bloomberg Law. The fees cover the nearly 217,000 hours the law firms spent representing the self-funded plans in the class-action lawsuit and the United Food & Commer- cial Workers & Employers Benefit Trust, as well as the state attorneys. The 32 percent fee falls within the pre- vailing range of 25 percent to 40 percent in similar cases, according to the report. "Together, we conducted ourselves as a single virtu- al law firm, efficiently combining the many talents of the various legal professionals that were necessary to successfully represent UEBT and overcome what would soon become a scorched-earth defense by Sutter and the five highly skilled law firms and scores of lawyers that represented it in this litigation," wrote Richard Grossman, Pillsbury & Coleman partner and co-lead counsel, in a fee petition, according to Bloomberg Law. The law firms filed the petition ahead of final approv- al of the proposed all-cash settlement. The hearing is slated for July 21 in California Superior Court. n Despite tax breaks, nonprofit hospitals not matching charity care of for-profit counterparts By Alia Paavola D espite receiving sizable tax exemptions to help offset uncompensated care, nonprofit hospitals provided low- er levels of charity care than for-profit hospitals, accord- ing to a study published April 5 in Health Affairs. For the study, researchers analyzed Medicare cost reports from 2018 to understand hospitals' charity care spending. The re- port included data from 1,024 government, 2,709 nonprofit and 930 for-profit hospitals. Researchers found that for every $100 in total spending, non- profit hospitals provided $2.30 in charity care, for-profit hospi- tals provided $3.80, and government-run hospitals provided $4.10, according to the report. Further, in 46 percent of hospital service areas containing all three types of hospitals, government and nonprofit hospi- tals had a lower aggregate charity-care-to-expense ratio than for-profit hospitals The study findings prompted the authors to raise questions about whether nonprofit hospitals are meeting their mission to provide charity care in exchange for their tax exemptions. The authors outlined several recommendations to help boost hospital charity care spending, including creating a system to publicly rank hospitals by the amount of charity care provided, requiring nonprofit and government hospitals to meet thresholds for charity care or revisiting tax-exempt rules for some hospitals. n

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