Nevada Jury: Health insurers owe emergency room doctors $ 60 million in damages

LAS VEGAS (AP) – The nation’s largest health insurance company and its Nevada branches were found liable for $ 60 million in punitive damages on Tuesday for underpaid non-network emergency medics.

A state jury said three plaintiffs, led by the Emergency Services TeamHealth, should each receive $ 20 million shares from Connecticut-based United Healthcare Insurance Co. and five subsidiaries, including the two dominant providers in the Las Vegas area : Sierra Health and Life Insurance Co. and Nevada Inc.’s Health Plan

“You have been able to get away with this so far,” said plaintiffs attorney John Zavitsanos, the eight jurors who passed last week to plaintiffs Fremont Emergency Services (Mandavia) Ltd., Team Physicians of Nevada-Mandavia PC and US $ 2.65 million The parent company of Ruby Crest Emergency Medicine had awarded Dollars damages.

United Healthcare’s vice president of communications, Dustin Clark, said Tuesday the company is monitoring the proceedings in Nevada state court. He made no immediate comment after reading out the claims for damages.

Appointments are expected. Daniel Polsenberg, a Las Vegas attorney representing the defendant, asked Clark County District Court Judge Nancy Allf to set up a post-ruling hearings. No appointments were set immediately.

Zavitsanos and Houston-based attorney Joseph Ahmad had demanded punitive damages from United Healthcare between $ 100 million and $ 1 billion. They characterized the parent company as a “Fortune 5” member, one of the largest companies in the country.

“The only thing they understand is money,” Zavitsanos said, ending his appeal to the jury to send a message that defendants, including United Healthcare Insurance Co., United Health Care Services Inc. and UMR Inc., were doctors , Anesthetists and nurses injured.

Dr. Scott Scherr, director of emergency room at Sunrise Hospital & Medical Center in Las Vegas and regional medical director of TeamHealth, testified during the month-long process. He was relieved after the judgments.

“A jury of my colleagues recognized the value of emergency medicine in Nevada,” said Scherr, who led trauma teams treating seriously injured victims after the deadliest mass shooting in modern US history in October 2017 at a concert on the Las Vegas Strip. 58 people died that night; Hundreds were injured.

“I hope this sends a message to United Healthcare about the importance of our frontline people,” said Scherr.

In emergency rooms where the law does not allow patients to be turned away, medical services that treat sore throats, broken ankles, heart attacks, and gunshot wounds may not be covered by patient health insurance.

Testimony showed that United Healthcare cut reimbursements to providers outside the network by more than half from 2017 to 2020 – from $ 528 to $ 246.

“United thought for too long that they could do what they wanted,” said Zavatsanos after the jury was dismissed. “Despite the tremendous efforts of TeamHealth, lawmakers, and people in the industry to listen, it took eight ordinary citizens to hopefully make more change than anything that has been done before.”

He added, “This is a victory today for all Nevada frontline heroes, frontline emergency rooms, medical assistants and nurses.”

In court, attorney K Lee Blalack II, who represented the defendants, reminded the jury that the compensation claim they received in their Nov. 29 liability judgment was about a quarter of the controversial billing fee of $ 10.4 million who were the focus of the contact injury case.

“My customers have heard you loud and clear,” he said, hoping the jury would carry out an equally thorough analysis on Tuesday. The jury deliberated for about two hours.

Blalack admitted that punitive damages were on the table and called $ 5.5 million an “appropriate sum” for a “payment dispute between large companies”.

More than that would be “monstrous,” “unfair,” and “an obscene godsend for the largest emergency room recruiter in the country,” said Blalack, referring to Tennessee-based TeamHealth.

The civil lawsuit was filed in April 2019 by Fremont and the other two groups representing off-grid providers in hospitals in and around Las Vegas and in the rural towns of Fallon and Elko, Nevada.

Rebecca Paradise, Senior Vice President of Out-of-Network Payment Strategy at United Healthcare, was questioned extensively and repeatedly by Ahmed on Tuesday about the impact of the ruling on her company.

In more than an hour of testimony, Paradise refused to indicate any changes administrators could make to billing practices based on a ruling it called “influential” but reached only a week ago.

United Healthcare has tens of millions of policyholders in the US

“I’m not saying that I agree or not. The verdict is the verdict, ”said Paradise. “We believe we are paying fair and reasonable prices. The jury found something different in this case and we will have to judge that. We have to understand what that means for the future. “

Ahmed showed the jury that while the insurer cut reimbursement rates, it was cashing in billions in profits and buying back shares, driving up prices for the company’s executives and shareholders.

Wayne Dolcefino, a Houston-based media advisor and former journalist who was closely monitoring the Nevada trial, said he was aware of similar reimbursement suits pending in states such as Arizona, Florida, New Jersey, New York, Oklahoma, Pennsylvania and Texas.

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