GREENEVILLE, Tenn. (WCYB) \u2014 Ballad Health has filed a lawsuit against UnitedHealth Group in federal court in Greeneville.<\/p>\n
Ballad alleges that UnitedHealth has “systematically denied, delayed or underpaid for care that physicians determined to be medically necessary, while also overstating to the federal government how sick its members are to collect higher taxpayer-funded payments through the Medicare Advantage program.”<\/p>\n
This marks the first time Ballad has sued an insurance company.<\/p>\n
News 5 has reached out to UnitedHealth Group for comment. We will update this article if a response is received.<\/p>\n
You can view the full news release from Ballad below.<\/p>\n
Ballad Health has filed a federal lawsuit in Greeneville, Tennessee, against UnitedHealth Group, one of the nation\u2019s largest health insurers.<\/p>\n
The system alleges that UnitedHealth has systematically denied, delayed or underpaid for care that physicians determined to be medically necessary, while also overstating to the federal government how sick its members are to collect higher taxpayer-funded payments through the Medicare Advantage program. Through the suit, Ballad Health aims to protect patients, physicians and hospitals across the Appalachian Highlands.<\/p>\n
The legal action marks the first time Ballad Health has sued an insurance company, and leaders said the decision was made only after years of attempting to resolve payment and patient care issues without success.<\/p>\n
\u201cTaking legal action was our last resort,\u201d said Alan Levine, chairman and CEO of Ballad Health. \u201cThis is not our first choice; it\u2019s not a choice we’ve had to make before. But we had to take action because we believe UnitedHealth\u2019s behaviors are so harmful to patients, doctors and community hospitals.”<\/p>\n
\u201cBallad Health has worked in good faith for years to ensure patients receive the care they need and that providers are treated fairly,\u201d added Anthony Argiropoulos, of Baker Donelson, who represents Ballad Health in the lawsuit. \u201cUnfortunately, UnitedHealth\u2019s practices have made it increasingly difficult to sustain access to care in rural communities, and a safety net system like Ballad Health has no choice but to fight back on behalf of its hospitals.\u201d<\/p>\n
Ballad Health serves a largely rural region, where more than 75% of patients rely on government programs such as Medicare or Medicaid or have no insurance at all. Roughly 55% of Ballad Health\u2019s patients are covered by Medicare, and nearly three-quarters of those are enrolled in Medicare Advantage plans \u2013 most with UnitedHealth.<\/p>\n
\u201cWhen a major Medicare Advantage insurer manipulates doctors, hospitals and patients in order to avoid living up to the agreement they made to pay for care for seniors, it puts seniors, access to doctors in rural communities and community hospitals at risk,\u201d Argiropoulos said. \u201cThese practices have led to longer hospital stays, delayed discharges and unnecessary strain on hospital capacity \u2013 all of which hurt patients.\u201d<\/p>\n
Ballad Health said UnitedHealth\u2019s denials of post-acute care for seniors can leave patients hospitalized longer than needed, increasing the risk of hospital-acquired conditions, contributing to longer wait times for emergency and inpatient services and, ultimately, costing patients and hospitals more money.<\/p>\n
\u201cUnitedHealth has already acknowledged the added cost of prolonged hospital stays by agreeing to reimburse Ballad Health for caring for patients who require longer inpatient care,\u201d added Argiropoulos. \u201cHowever, the company has failed to honor that commitment and has withheld millions of dollars it agreed to pay.\u201d<\/p>\n
The complaint also cites national reports alleging that UnitedHealth subsidiaries have acquired physician practices and used aggressive coding tactics to increase payments from Medicare, while simultaneously pressuring providers to see more patients and reduce spending on care.<\/p>\n
\u201cIt\u2019s wrong to tell the federal government that patients are sicker to get more taxpayer money and then deny those same patients the care they need,\u201d Argiropoulos said. \u201cThat behavior harms seniors, physicians and the very communities these programs are meant to serve.\u201d<\/p>\n
Ballad Health said it will not renew its Medicare Advantage contract with UnitedHealth when it expires on June 30, 2027. The decision applies only to that contract; Ballad Health will continue to work with UnitedHealth on its commercial, Medicaid and exchange insurance plans when those contracts come up for renewal.<\/p>\n
\u201cRural systems like ours can\u2019t keep contracting with companies like UnitedHealth on Medicare Advantage when the math no longer works,\u201d said Levine. \u201cOur mission is simple \u2013 to keep care local, keep hospitals open and ensure access to needed specialists and services.”<\/p>\n","protected":false},"excerpt":{"rendered":"GREENEVILLE, Tenn. (WCYB) \u2014 Ballad Health has filed a lawsuit against UnitedHealth Group in federal court in Greeneville.…\n","protected":false},"author":2,"featured_media":242165,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[97,252,253],"class_list":["post-242164","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-health","tag-health-care","tag-healthcare"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/242164","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=242164"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/242164\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/242165"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=242164"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=242164"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=242164"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}