SCRANTON — Two Pennsylvania-based emergency room practices that have filed a federal racketeering and corruption lawsuit against affiliates of a major insurance group don't have much of a case, the spokesperson for the insurance group said.
"We have reviewed the claims against UnitedHealthcare – they are meritless," a UnitedHealthcare spokesperson said in an email statement to the Pennsylvania Record.
UnitedHealthcare otherwise doesn't have much else to say, the spokesperson said in a separate telephone interview.
"This is the preliminary stage; we're not saying much at this point," the spokesperson said.
The UnitedHealthcare affiliates are accused in a lawsuit filed July 11 in the U.S. District Court for Pennsylvania's Middle District of cutting their reimbursement rate for non-participating claims "to less than half the average reasonable reimbursement rate" beginning in January.
"Defendants' drastic payment cuts are entirely inconsistent with the established rate and history between the parties," the 47-page lawsuit said.
Defendants in the case are accused of violating the Racketeer Influenced and Corrupt Organizations Act and Pennsylvania laws against breaching implied-in-fact contract and unjust enrichment and that their activities "constitute a pattern of unlawful racketeering activity," the lawsuit said.
Plaintiffs Emergency Care Services of Pennsylvania and Emergency Physician Associates of Pennsylvania describe themselves in their lawsuit as "local hospital-based physician practices who provide emergency medical care to all patients, regardless of insurance coverage or ability to pay." Emergency Care Services is based in Langhorne and Emergency Physician Associates is based in Reading, according to their lawsuit.
Defendants in the case are UnitedHealth Networks Inc., UnitedHealthCare of Pennsylvania Inc., United HealthCare Services Inc., UnitedHealthCare of New England Inc., UnitedHealthCare Inc., UnitedHealthCare Insurance Co. and UnitedHealth Group Inc.
UnitedHealth Group is the largest single health carrier in the U.S.
The physician practices claim the defendants manipulated payment rates "to defraud plaintiffs and deny them reasonable payment for their services, which the law requires," the lawsuit said. "Defendants have reaped millions of dollars from this illegal, unfair and fraudulent conduct, and stand to reap millions more if their conduct is not stopped."
Plaintiffs are seeking declaratory relief, asking the court to declare the defendants are obligated to pay plaintiffs at a "reasonable value" for emergency medical services rendered for non-participating claims, the lawsuit said. Plaintiffs also seek, among other things, treble damages, a jury trial and "other relief as the court determines to be just and proper."
The case is assigned to U.S. District Court Judge Sylvia H. Rambo
The case was filed on behalf of Emergency Care Services and Emergency Physician Associates by Bridget Montgomery, a member in Eckert Seamans Cherin & Mellott's Harrisburg office, and Florida attorneys Alan Lash, Justin Fineberg and Michael Ehren, partners Lash & Goldberg in Miami.