A team of New Jersey lawyers represented a major health care company that was awarded $91.2 million in Florida arbitration proceedings with UnitedHealthcare.
A three-member panel from the American Arbitration Association made the award to Envision Healthcare of Nashville on claims that UnitedHealthcare routinely paid Envision less than the contracted amount for medical services in 2017 and 2018.
Anthony Argiropoulos headed a team from the Princeton office of Epstein Becker & Green that represented Envision.
Envision announced the award Wednesday.
In addition to the $91.2 million, the panel will separately assess prejudgment interest and consider Envision’s entitlement to attorney fees, costs and expenses as a prevailing party.
Envision has also filed a petition in the U.S. District Court for the Southern District of Florida to confirm the award.
Reduced Reimbursement Rates
Envision provides services such as emergency medicine, anesthesiology, radiology and neonatology, and it is a leader in ambulatory surgical care.
UnitedHealthcare had an in-network agreement with Envision, but it unilaterally reduced reimbursement to Envision in violation of their agreement, Argiropoulos said.
Envision sued UnitedHealthcare in the Southern District of Florida in 2018, claiming that it repeatedly breached a 2012 contract between the parties.
The suit said UnitedHealthcare adjusted downward its contractual reimbursement rates with Envision.
But a federal judge granted UnitedHealthcare’s motion to compel arbitration of the dispute, pursuant to a clause in the contract. UnitedHealthcare also accused Envision of overbilling and engaging in egregious billing practices.
UnitedHealthcare did not respond to a request for comment from Law.com. The company said in a statement to the Financial Times that it would “continue efforts to protect our members and customers from the small number of bad actors … who demand unreasonable and anti-competitive rates for their services, and drive up the cost of care for everyone.”
5 Years of Arbitration
Arbitration in the Envision case began in 2018 and is just now completed.
The panel found in favor of Envision, and rejected the claims by UnitedHealthcare, Argiropoulos said.
The case’s five-year duration was likely longer than it would take in court, Argiropoulos said.
The proceedings culminated in a three-week hearing in Miami that took place during a major storm, he said. The calculation of damages was particularly complex, requiring multiple expert witnesses, Argiropoulos said.
“While we are very pleased with the outcome, it should not take five years to get paid for the lifesaving care our clinicians provide,” Envision CEO Jim Rechtin said in a statement. “It is challenging to create a stable environment for our teams when health plans choose not to pay their bills. This decision sets a critical precedent for insurers like UnitedHealthcare to pay in full for the high-quality care its members receive in their most acute time of need.”
‘Very Technical … Very Expensive’
“One of the benefits of arbitration is the panel is so experienced dealing with these types of issues and complex economic analysis that we didn’t have to break it down to the level that we typically break it down,” Argiropoulos said. “It could have been more challenging in a jury trial. There’s so much data involved that a jury could end up glazing over or having a difficult time, although I will tell you that I have found in my practice, which involves complex commercial cases, juries are smart—they make the right calls.”
Argiropoulos’ team on the case included William Gibson, Scheherazade Wasty and Thomas Kane. The firm has a busy practice representing health care providers in disputes with insurance companies.
“Doctors are now spending substantially more of their time than you would ever imagine fighting with their insurance companies over payments, basically being distracted over the actual practice of medicine. It is shocking and it is not just in New Jersey, it’s across the country,” Argiropoulos said.
The Envision case is a particularly favorable outcome for such a dispute, he said.
“These cases are very difficult, they are very technical, they are very expensive. A lot of smaller practices have to fold under the pressure because they can’t afford it. There are instances where physicians are being choked out because these insurance companies have such economic power. They do what they want,” Argiropoulos said. “A reason why we are so proud of this achievement is because it is so uncommon. It’s an instance where a provider said we’re not going to take this, we’re going to fight for their rights, and they did. We’re proud of our team and we’re proud of the client, and we think this is pretty amazing.”