番茄社区

U.S. Anesthesia Partners -- a single-specialty practice that operates in nine states -- is suing UnitedHealthcare (UHC) in Texas and Colorado, alleging the insurance titan forced doctors out of its network and launched a series of anti-competitive actions against the group.

USAP last month filed separate lawsuits in and , both making similar claims against UHC. The physician-owned, private equity-backed practice -- which in total serves more than 2.3 million patients a year -- says UHC's actions have taken aim at its operations in both states.

Central to the claims is that UHC made moves to force doctors out-of-network -- harming USAP's revenues and squeezing the practice from all sides "like a boa constrictor," as the group's Colorado suit put it.

USAP alleged in each complaint that the efforts "were not enough to satiate United's greed, so United then embarked on a scheme to interfere with, undermine, and eliminate [USAP's] existing business and contractual relationships with healthcare facilities, individual surgeons, and patients."

USAP stated in each complaint that the alleged scheme has involved bribing in-network surgeons with new contracts that provide incentives -- such as about 50% more compensation -- in exchange for their commitment to steer patients away from USAP. It also alleged that the insurer imposed penalties on hospitals and other facilities that have contractual agreements with USAP.

USAP noted in its complaints that UHC's parent company also owns Optum, which -- through its division OptumCare -- operates a physician practice organization with tens of thousands of employees and affiliated physicians and plans to add more. The group noted that Optum, in turn, owns a significant interest in Sound Physicians, which includes anesthesiologists and certified registered nurse anesthetists.

"In this way, United and its affiliates have extended their tentacles into virtually every aspect of healthcare, allowing United to squeeze, choke, and crush any market participant that stands in the way of United's increased profits," USAP stated in its complaint filed in Texas. "UHG [UnitedHealth Group, the parent company], United, and their affiliates are abusing their collective behemoth strength during a global pandemic to drive revenue away from healthcare providers and toward United."

"Simply put, the less United pays or reimburses healthcare providers for their services, the more United profits from the ever-rising insurance premiums it collects," USAP added.

USAP stated in each complaint that patients don't benefit from such trends and healthcare costs don't decrease. Rather, the practice stated, patients -- including UHC's members -- risk losing access to high-quality anesthesia providers. Plan sponsors may also pay more as higher surgeon fees may be passed through to them, and the total cost of care may be higher as well. Clinical outcomes, USAP alleged, may be worse.

USAP declined to comment on the suits beyond what it stated in its complaints.

Though the practice alleges in its complaints that UHC's actions have been taken to boost the insurer's own profits, UHC blames rate demands made by USAP.

In a statement provided to 番茄社区, the company said "USAP's lawsuit is just the latest example of the group's efforts to pressure us into agreeing to its rate demands and to distract from the real reason that it no longer participates in our network.... The reality is that many private equity-backed physician staffing companies like USAP expect to be paid double or even triple the median rate we pay other physicians providing the same services."

"While these egregiously high rates help meet the profit expectations of their private equity owners, they also drive up the cost of care and make health care less affordable for people across the country," UHC said.

UHC asserted that a few physician staffing companies -- often backed by private equity -- are trying to protect their ability to charge high rates, which drive up the cost of care for everyone, including the insurer's employer customers.

UHC said that reimbursing USAP at the median rate the insurer pays anesthesiologists in Texas and Colorado would save employers in Texas more than $104 million in a single year, and employers in Colorado more than $19 million. Such savings could be passed on to employees through steady or lower premiums, or other benefits.

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