Radiology Partners scores key victory in court battle with UnitedHealthcare
Radiology Partners has scored a key victory in its ongoing court battle with UnitedHealthcare, the El Segundo, California, imaging group announced Thursday.
The nation’s largest commercial insurer first filed suit against the country’s biggest radiology group in April, alleging Rad Partners has perpetrated a “pass through billing scheme” in its “unscrupulous pursuit of profits.” RP has sought a speedy resolution via arbitration, rather than a drawn-out court case, noting that the matter largely mirrors an ongoing payment dispute with UnitedHealthcare.
A California federal court granted the request Wednesday, agreeing that the complaint is nearly identical to claims in the existing underpayment dispute between the parties.
“We stand by the integrity of RP and our affiliated practices and reiterate the claims asserted by UHC are completely without merit,” Rich Whitney, MBA, Rad Partners board chair and CEO, said in a statement. “I am pleased with the court’s decision, and I am hopeful we can soon refocus on what matters most—providers and payers working collaboratively for the good of patients, employers and the healthcare system overall.”
RP previously entered a motion to compel arbitration in August. UnitedHealthcare responded by filing an amended complaint, with Judge Michael W. Fitzgerald asking the practice to amend its request based on the new document. Rad Partners obliged, and the judge granted the request on Sept. 27, court documents show.
“Accordingly, the court stays this action pending completion of the arbitration,” the order states. “The parties shall file a joint status report every 90 days apprising the court of the status of the arbitration proceedings, with the first report due on January 29, 2024.”
Rad Partners-affiliated practice Singleton Associates originally filed an arbitration demand in April 2022, claiming “significant underpayments” by UnitedHealthcare of Texas, according to court documents. The Houston, Texas, imaging group estimates that UHC has caused more than $100 million in damages by breaching their agreement and systematically underpaying physicians.
UnitedHealthcare declined to comment when reached by Radiology Business Thursday. The Minnetonka, Minnesota-based healthcare giant alleges that RP would pinpoint affiliated practices with higher negotiated rates and then use radiologists from other parts of the company to bill through such practices to earn the heftier amount. Those include Singleton Associates, Mori, Bean & Brooks PA in Jacksonville, Florida, and Greensboro Radiology in Charlotte, North Carolina. The alleged scheme has resulted in UHC paying tens of millions of dollars in reimbursements to which the insurer believes that RP and its affiliates were not entitled.
RP’s allegations come after fellow private equity-backed radiology provider Envision Healthcare secured its own arbitration victory over UHC. Mediators determined that UnitedHealthcare breached its contract with Envision by “unilaterally reducing reimbursement rates,” ordering the insurer to pay a $91 million judgment to the Nashville-based multispecialty group.
The Department of Labor also sued a third-party administrator owned by UnitedHealth on July 31, alleging it improperly denied claims for emergency services.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.