Tennessee-based well being system Ballad Well being is suing healthcare big UnitedHealth Group, alleging the insurer routinely denies or delays care physicians deemed vital.
The well being system stated in a press launch that the insurer has “systematically denied, delayed or underpaid for care that physicians decided to be medically vital” whereas reporting to the feds that sufferers are sicker than they’re to safe further payouts in Medicare Benefit (MA).
Ballad stated it doesn’t intend to resume its MA contract with UnitedHealth, which is ready to finish June 30, although it is going to proceed to work with the insurer for its business, Medicaid and market plans shifting ahead.
The supplier stated its affected person inhabitants is basically rural, with about 55% enrolled in Medicare. About three-quarters of its Medicare sufferers are enrolled in MA, and most safe protection by way of UnitedHealthcare.
That is the primary time it is taken authorized motion in opposition to a well being insurer, based on the announcement.
“Taking authorized motion was our final resort,” stated Alan Levine, chairman and CEO of Ballad Well being, within the announcement. “This isn’t our first alternative; it’s not a alternative we’ve needed to make earlier than. However we needed to take motion as a result of we imagine UnitedHealth’s behaviors are so dangerous to sufferers, docs and neighborhood hospitals.”
Per the announcement, Ballad stated denied claims for post-acute care can result in longer affected person stays, growing the price for care in addition to the danger for antagonistic occasions like hospital-acquired circumstances.
A spokesperson for UnitedHealthcare stated the insurer is “conscious” of the lawsuit however “we’ve got not but been formally served.”
“We imagine the allegations are with out advantage and intend to vigorously defend ourselves in opposition to them,” the spokesperson stated.
Within the lawsuit, Ballad Well being alleges that UnitedHealth’s conduct has induced $65 million in damages to the well being system over the previous 5 years, with these impacts rising because of the “ongoing conduct.”
“Ballad Well being has labored in good religion for years to make sure sufferers obtain the care they want and that suppliers are handled pretty,” stated Anthony Argiropoulos of Baker Donelson, which represents Ballad Well being within the lawsuit, within the announcement.
“Sadly, UnitedHealth’s practices have made it more and more tough to maintain entry to care in rural communities, and a security web system like Ballad Well being has no alternative however to struggle again on behalf of its hospitals,” stated Argiropoulos.
