UnitedHealth accused of illegally deflating reimbursements

The complaint includes a number of claims, including breach of suggested contract and civil conspiracy, according to Law360..

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The plaintiffs allege UnitedHealth paid them in between 75 percent and 90 percent of billed value for out-of-network claims for many years. After executing Data iSight, the compensation rate apparently dropped to between 15 percent and 20 percent of billed worth for claims..

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” It does not use the regional information it claims to, and exists merely to paper over the naked, unexcused, and illicit greed of the United defendants, whose growth in revenue comes at the direct expense of front-line emergency situation space physicians,” specifies the problem..

In a complaint submitted Sept. 15, Emergency Care Services of Pennsylvania and Emergency Physician Associates of Pennsylvania declare UnitedHealth employed a data analysis firm to develop market-based repayment rates. However, the complainants allege the tool utilized to come up with the rates, called Data iSight, does not utilize details about services or rates in local markets..

Two hospital-based physician groups have submitted a claim implicating UnitedHealth Group of improperly cutting repayments to out-of-network providers, according to Law360..

Counsel info for UnitedHealth wasnt instantly available, according to the report. The case is pending in the Court of Common Pleas of Philadelphia County..