Becker's ASC Review

12 ASC MANAGEMENT UnitedHealthcare to pay TeamHealth $10.8M for alleged underpayments: What ASCs need to know By Patsy Newitt A n arbitration panel in Florida has ruled that UnitedHealthcare must pay a TeamHealth clinician group $10.8 million for alleged underpayments from 2017 to 2020. Here's what ASCs need to know: 1. e verdict comes aer a jury ruled in December 2021 that UnitedHealthcare must pay $60 million in punitive damages following a lawsuit physician staffing firm TeamHealth filed against the payer over thousands of provider underpayments for emergency services. 2. ere are currently eight additional pending lawsuits challenging the alleged underpayments. 3. In October 2021, UnitedHealthcare sued TeamHealth for allegedly upcoding $100 million worth of claims for emergency services since 2016. In May, a judge refused to dismiss the suit. 4. In a Nov. 30 release shared with Becker's, TeamHealth medical groups anticipated an additional award of millions of dollars in prejudgment interest and cost. 5. A UnitedHealthcare spokesperson told Becker's in a Dec. 1 email that the panel issued "a compromise decision, awarding TeamHealth only a fraction of what it was undeservingly seeking." "It also ruled that TeamHealth's implied contract and unjust enrichment causes of action had no merit," the spokesperson said. "TeamHealth continues to use litigation to distract from the real reason it no longer participates in our network; it expects to be paid double or even triple the median rate we pay other physicians providing the same services. TeamHealth's actions are driving up the cost of healthcare for everyone." n 3 major health systems post billion-dollar losses: What ASC leaders should know By Patsy Newitt H ospitals and health systems, like ASCs, are being affected by rising labor and supply costs while reimbursements remain low. Three major health systems have posted multibillion losses in either the third quarter or the first nine months of 2022. 1. Providence, a 51-hospital system headquartered in Renton, Wash., ended the first nine months of 2022 with an operating loss of $1.1 billion. The system said in a news release that its third quarter financial results showed the "ongoing impact of inflation, the national healthcare labor shortage, delayed reimbursement from payers, global supply chain disruptions and financial market weakness." 2. Oakland, Calif.-based Kaiser Foundation Health Plan, Kaiser Foundation Hospitals and their subsidiaries reported a net loss of $1.5 billion for the quarter ending Sept. 30. The company posted total operating revenues of $24.3 billion and total operating expenses of $24.3 billion for the quarter. 3. Cleveland Clinic reported a more than $1 billion loss for the first nine months of 2022. The 20-hospital health system reported $469.2 million in third quarter net losses, a significant drop from $422.2 million net income the year prior. Cleveland Clinic's investment returns were nearly $682 million lower for the third quarter of 2022 than 2021 due to "unfavorable financial markets," according to the health system's financial report. n 4 ASC, practice closures in 2022 By Patsy Newitt Here are four ASC and practice closures Becker's covered in 2022: 1. In April, Redlands Mesa Surgery Center and Colorado Injury and Pain Specialists in Grand Junction, Colo., closed its doors. The two businesses are in a building owned by Toledo, Ohio-based Deca Health. 2. In early August, Orange County, N.Y.-based Garnet Health scrapped multiple outpatient services, citing low patient volumes, increasing costs and supply shortages. 3. Later in August, Garnet Health announced it is also closing five physician practices and laying off 29 employees. 4. The Surgery Center of Fort Collins (Colo.), which closed Aug. 12, is still working on collecting past due bills more than two months after it announced it was closing for good. n

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