Case Summaries - Healthcare

Archive for the ‘Healthcare’ Category
Fremont Emergency Services (Mandavia), et al. vs. UnitedHealth Group, Inc. et al.

In a closely watched December 2021 trial, a Nevada jury handed AZA client TeamHealth yet another trial victory on behalf of underpaid emergency room doctors, this time with a $62.65 million jury award against United Healthcare, the largest insurer in the nation. With attorneys’ fees, the award came to more than $75 million. 

The seven-week trial put several Las Vegas area ER physicians groups up against a cluster of United Healthcare affiliates. The jury found that the insurers cheated the doctors groups out of more than $2.65 million in payments and also awarded $60 million in punitive damages. TeamHealth plaintiffs will also seek attorney’s fees. Texas Lawbook featured the Nevada case as the top story in Top Commercial Litigation in 2021 

The lawsuit is one of many TeamHealth affiliates have filed against various insurers across the country to stop systematic underpayment of ER doctors groups by insurance companies. AZA has already won two other jury trials for TeamHealth doctors in several states and settled a handful of other cases. This Nevada win against the largest U.S. insurer could be a bellwether for the more than two dozen similar cases around the nation against various insurers. 

The jury found the insurance affiliates liable for unjust enrichment, breach of contract and unfair insurance practices. The court had ruled that the insurers willfully hid evidence in this case. 

TeamHealth is the nation’s largest clinical practice. It operates in 47 states, contracts with 16,000 healthcare professionals and treats 30 million patients annually. 

The AZA team worked with local counsel was Pat Lundvall, Florida attorney Justin Fineberg and Carol Owen of TeamHealth.

AZA lawyers: John Zavitsanos, Joe Ahmad,  Jane Langdell Robinson, Jason McManis,  Kevin Leyendecker, Michael Killingsworth,  Louis Liao

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ACS Primary Care Physicians Southwest, PA et. al v. Molina Healthcare, Inc. and Molina Healthcare of Texas Inc.

A Harris County jury awarded $19.1 million to a group of emergency room doctors in June 2021 in the first case in the nation to litigate emergency room physicians’ out-of-network pay from private insurance companies under the Affordable Care Act. 

The jury awarded physician groups ACS Primary Care Physicians Southwest PA and Emergency Services of Texas, affiliates of non-party physician led TeamHealth, $1.58 million in actual damages and $17.5 million in punitive damages from Molina Healthcare of Texas Inc. The  verdict found Molina routinely underpaid claims and failed to follow insurance laws that require they pay the usual and customary rates for the geographic area.  

Jurors were told that the case was being watched nationally by emergency room doctors and nurses and by insurance companies elsewhere who have tried to get around paying the going rate. 

The Texas Insurance Code requires private insurance companies like Molina to pay doctors the “usual and customary rate” for a geographic area. According to trial testimony, the rate from other private insurers is $1,042 per claim, but Molina was paying the ER doctors only $151 per claim. The plaintiffs showed the defendants violated the Texas Insurance Code and were deceptive in breaching their promises. 

AZA tried the case with Collin Kennedy of Hanshaw Kennedy Hafen.  

AZA lawyers: John Zavitsanos, Sammy Ford IVJane Langdell Robinson,  Michael KillingsworthLouis Liao 

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Southeastern Emergency Physicians, LLC v. Arkansas Health & Wellness Health Plan, Inc., Centene Corporation et. al

A six-person jury in August 2020 awarded a $9.4 million verdict on behalf of Southeastern Emergency Physicians, LLC, an affiliate of TeamHealth Inc., finding that Centene Corporation and Ambetter, Novasys and Celtic, its commercial insurance subsidiaries, systematically tried to strip the 120 emergency clinicians in the physician’s group of most of their pay.

In one of the first in-person jury trials in Arkansas since the COVID-19 virus hit, the jury in U.S. District Judge Brian S. Miller’s court found that the defendants grossly underpaid and breached their agreement with the emergency room doctors. The jury awarded $9.4 million in damages and the judge added an additional $1.24 million in attorneys’ fees and costs.

AZA won the case though they were hired to do so six days before jury selection. See the Texas Lawbook story on this win Six Days Notice, Six Witnesses, Six Jurors, 150 ER Doctors, Two Ticked Off In-House Counsel and a $9.4M Verdict (subscription required).

The jury found that the Centene-controlled commercial insurance company and health network since 2014 had paid the emergency clinicians’ groups only 20% of the amount they were owed for their services.  The jury also heard how Centene tried to obfuscate their ownership of the companies and the entities responsible for paying the doctors. This case led to settlements with Centene in this case and others.

AZA tried the case with Collin D. Kennedy of Frisco, Texas-based Hanshaw Kennedy Hafen, LLP. and Little Rock lawyers from Wright Lindsey Jennings.

AZA attorneys: John Zavitsanos, Kevin Leyendecker and  Michael Killingsworth

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