-
UnitedHealthcare sues Radiology Partners over billing dispute
Imagine this – United health care complaining about unfair practices…….
We will see which avaricious, unethical business is best at avarice.Henry Kissinger said this about the Iran-Iraq war: “It’s a shame there can only be one loser”
apropos
-
53 Replies
-
My thoughts exactly!!
-
The Golden Rule: He who has the gold, makes the rules.
RP may control ‘some’ of the workforce, for now, but that can all change quickly.
United controls the money and, sadly, a lot of the patients.
I know who my money would be on.
-
Quite ironic. Its like watching two people fight to submission, both of which you barely care anything about. Not sure who I want to win one company whose business practice is to deny care to people based on greed and another whose greed has led them to skim radiologists salaries while also participating in alleged shady business practices. I kind of hope that RP will burn for this and that it will expedite their fall. But on the other hand, I dont like seeing big health insurance companies flexing their muscles out of greed. Ill have to ponder it
-
i think its over 75k
-
[link=https://radiologybusiness.com/topics/healthcare-management/healthcare-economics/unitedhealthcare-radiology-partners-private-equity?utm_source=newsletter&utm_medium=rb_newsalert]https://radiologybusiness…tm_medium=rb_newsalert[/link]
-
Quote from theSNACman
i think its over 75k
no, UH says it is tens of millions.”
United is seeking to recoup the amounts it claims that RP has “unlawfully obtained from the United plaintiffs and their plan sponsors.” It alleges that the “pass-through billing scheme caused United tens of millions of dollars in damages,” and noted that Singleton was paid under the agreement at reimbursement levels six times what Medicare would have reimbursed for the same services.”this is interesting – Doesn’t RP present their employment opportunities as “partnerships” I thought they did. Of course, we all know better
There is this in the article
“United said the contract also required Singleton to notify it of any changes in ownership and control. However, it claims in the suit that in October 2014, Singleton filed an amended and restated certification of formation that changed its ownership and made Anthony Gabriel — RP’s co-founder and chief operating officer — its only member, officer, or director. United claims, though, that it was never informed of the ownership change.”
-
Quote from Phil Shaffer
noted that Singleton was paid under the agreement at reimbursement levels six times what Medicare would have reimbursed for the same services.
wow, 6x medicare with United?-
In case anyone else was wondering what a “pass-through” billing scheme is. ChatGPT said the following:
A pass-through billing scheme is a fraudulent activity in which an intermediary entity, such as a shell company or rural hospital, submits false claims to a healthcare insurance company or government program for services that were not actually rendered. In return, the intermediary entity receives a percentage of the reimbursements paid by the insurer or program, while the actual provider of the services receives a smaller portion or no payment at all [[link=https://www.justice.gov/opa/pr/ten-defendants-charged-14-billion-rural-hospital-pass-through-billing-scheme]2[/link]].Pass-through billing is not permitted by some insurance companies, such as UnitedHealthcare, and providers may only bill for services they or their staff perform. Billing on behalf of another provider who performed the services is not allowed [[link=https://www.uhcprovider.com/en/admin-guides/administrative-guides-manuals-2022/ch10-claims-process-2022/pass-bill-clia-reqreimb-pol-ch10-guide.html]3[/link]].
Auditors should scrutinize steep fluctuations in the cost of goods sold to identify false invoices and their issuers, which may indicate a pass-through billing scheme [[link=https://www.journalofaccountancy.com/issues/2002/aug/billingschemespart2passthroughs.html]1[/link]].
In summary, a pass-through billing scheme is a fraudulent activity where an intermediary entity submits false claims for services not rendered, receiving a percentage of reimbursements paid by an insurer or program while the actual service provider receives a smaller portion or no payment at all. It is not permitted by some insurance companies and should be closely monitored by auditors.
-
Quote from Teedevil
In summary, a pass-through billing scheme is a fraudulent activity where an intermediary entity submits false claims for services not rendered, receiving a percentage of reimbursements paid by an insurer or program while the actual service provider receives a smaller portion or no payment at all. It is not permitted by some insurance companies and should be closely monitored by auditors.
this sounds like your employer having you sign a document that assigns your billings to them. You do the work, they bill and collect. You get a fraction
-
-
“On October 31, 2014, Singleton filed an Amended and Restated Certificate of Formation that changed Singletons ownership and made Anthony Gabriel the only member, officer, or director of Singleton. In addition to becoming the sole member, Gabriel became the sole officer and director of Singleton.”
Rad partners? Gabriel isn’t even a radiologist.-
This is just a glimpse. I’ll bet RP is pass through billing in every state they operate in. Picking the oldest and therefore highest paying group contract and then billing all radiologists through that contract. Ingenious.
I thought they would only take from rads. Guess a dollar is a dollar.-
Uniteds 1998 Network Contract with Singleton
Singleton and United entered into a Medical Group Participation Agreement effective January 1, 1998 (the Agreement). At the time, Singleton was a radiology group made up of individual radiologists or Medical Group Physicians that provided services in Houston at two facilities: St. Lukes Episcopal Hospital and Texas Childrens Hospital.
Under the Agreement, United agreed to reimburse Singleton at a high rate of reimbursement totaling the lesser of (1) Medical Groups Customary Charge, less any applicable Member Expenses, or (2) 80% of Medical Groups 1997 fee schedule as per the attached Payment Exhibit for such Health Services, less any applicable Member Expenses.
Medical Groups 1997 fee schedule likely 300% of Medicare, not 600%.
Astounding rates!-
Check out their google reviews. Theyve been scamming for years.
Radiology Partners Phoenix
[link]https://maps.app.goo.gl/8i4XrDrXHDTuDRUX6?g_st=ic[/link] -
Someone on here previously alleged that they did this in Wisconsin via apparently higher reimbursement rates at their Tennessee sweatshop. But this was a bit different- it was allegedly a remote Tennessee sweatshop crew reading the bulk of the wisconsin studies in their jammies for Tennessee rates.
-
Arbitrage play seems like business 101 to me.
-
Quote from Waduh Dong
Arbitrage play seems like business 101 to me.
Fraud isn’t business 101. Stealing and overbilling the patients who had United Healthcare isn’t business 101.
RP should pay massive fines to United (and United should in turn send that savings to their patients) and the C-suite of RP belongs in jail. -
If they did it to UHC they did it to all of the payors. All insurance carriers should investigate RP’s billing practices and so should the DOJ. This isn’t just about UHC Commercial products. Don’t forget that UHC also has Medicare Advantage products so now we are talking Federal monies. Where is the Department of Justice when you actually need them to look at something meaningful? Anywhere but up RP’s ass – that’s a fact.
-
[link=https://m.startribune.com/former-unitedhealth-ceo-made-142-2m-last-year/600171979/]https://m.startribune.com…m-last-year/600171979/[/link]
-
Quote from Waduh Dong
[link=https://m.startribune.com/former-unitedhealth-ceo-made-142-2m-last-year/600171979/]https://m.startribune.com…m-last-year/600171979/[/link]
[link=https://www.denverpost.com/2014/10/23/former-davita-insider-helped-build-case-that-led-to-389m-settlement/]https://www.denverpost.co…ed-to-389m-settlement/[/link]
Former DaVita CFO Rich Whitney was part of a scheme to defraud the Federal Government and MEdicare. He’s the person you’re defending that is now CEO of RP.
How much is RP paying you? I hope you’re only accepting cash and not stock. RP Bonds keep going down in price. They’re going to be in default just like Envision in a few months. -
Nobody is paying me anything (sadly). My only point here is that UHC isnt some wonderful highly moral outfit. Insurance companies arent some friend to the practicing physician.
Anyway, guess the courts will ultimately have the final say. It should be interesting to follow.
-
Quote from Joker33647
If they did it to UHC they did it to all of the payors. All insurance carriers should investigate RP’s billing practices and so should the DOJ. This isn’t just about UHC Commercial products. Don’t forget that UHC also has Medicare Advantage products so now we are talking Federal monies. Where is the Department of Justice when you actually need them to look at something meaningful? Anywhere but up RP’s ass – that’s a fact.
You really want UH to win this????
A clever mechanism to separate UH from some of the money they collect ostensibly to pay for medical bills seems OK to me. Of course UH will call it fraud. What else can they do.
But, per my first post, I don’t find RP to be a virtuous organization, either.
But at least some of the money goes to radiologists.This is a company that came to my group in the nineties with the following proposal:
We were approached by a business man who was going to be the intermediary between us and UH. We would agree to a substantial cut in our reimbursement from UH. I believe it was 50% or so. What did we get in return? We would get to keep the business. This guy was peddling the scheme to all the groups in town. I asked what is fee for his services was… 15% of the contract.
At the next meeting he introduced us to a physician who worked with him in the business, a retired ENT. The doc would be the intermediary between us and this businessman. I asked what his cut was. I was shocked they told me, but they did. It was either 10 or 15%.so you get the picture – previously we had a contract with UH that paid roughly 1.5 x medicare. You had two businessmen who came to us and threatened our contract if we didn’t sign to give them 25% of our contract, and we took about 50% less. What was the benefit to patients – nothing.
We were warned not to discuss this with the other groups in town, as that would be “collusion”
So all the groups in town refused this “attractive” package, and they went away. -
From where I sit, PE Funded companies like RP and insurance carriers like UHC are worse than Satan. RP for what it does to generally hardworking radiologists and for what it has done to private practice in America. UHC and others like them for the harm they cause physicians and more importantly for the harm they cause our patients/ their members in exchange for the all mighty dollar. This is just a matter of which wrong I would like to see corrected first. Only a company like UHC or a combination of several companies + CMS + DOJ can take out RP. We need them to bring down companies like RP and Envision. Once that is done we can focus on fixing the real healthcare problem in America. That’s my two cents.
-
I think we can all generally agree that they both kinda suck.
-
Envision is likely to be controlled by creditors soon.
[link=https://www.wsj.com/articles/kkrs-envision-weighs-handing-control-to-creditors-in-a-bankruptcy-30d5ed25]https://www.wsj.com/articles/kkrs-envision-weighs-handing-control-to-creditors-in-a-bankruptcy-30d5ed25[/link] -
Does that mean RP is on the chopping block within 6 months as well?
-
Here is what I think. Will it die? Yes, eventually. Will it be fast? No. RP will die a slow and painful death and not before negatively impacting radiologists, hospitals and patients. Radiologists will panic and leave RP. RP will respond by offering higher salaries. That alone will destabilize the market. Their shortage of radiologists will have adverse effects as related to quality. Hospitals will feel pain and patients will be misdiagnosed. Insurance carriers will continue to cut their reimbursement. RP will pass through the losses to the physicians they employ. When it does eventually die, Whitney and Gabriel will be significantly wealthier but will have left radiology completely destroyed and it will take years for us to rebuild. That is my prediction.
-
RP is still growing. When they stop growing we can talk about their demise.
-
Losing 5 contracts in Chicago this year is not growing. Please provide evidence of 5 new contracts in the last year. If you cant, then they are not growing. And if you cant provide evidence, that makes you a shill for RP. It seems you are holding some worthless RP shares. Just FYI those will be worth zero soon.
-
Actually provide 6. 5 would be break even. Thanks.
-
Growing???
LOL !!! -
Apparently RP picked up all of Envision’s HCA West Florida Division contracts including Brandon Hospital, South Bay Hospital, Medical Center of Trinity, etc. It was a Division level deal which they agreed to before the UHC lawsuit was initiated. If you can’t be good be lucky.
-
Joker,
All the past contracts, current contracts and contracts being worked on (before or after the lawsuit) will be scrutinized by the various hospital and health systems. -
Yeah everyone should scrutinize them. Take a look at themselves in the mirror and ask them if they want to work for a company that skims radiologists salaries and gets involved in lawsuits like this.
-
Growing
They are moving firmly into the lose a little on each unit and make it up in volume territory.
Profit margins will plummet without the ability to overcharge, legally or illegally. Plus radiologist costs increasing rapidly. Add the cost of debt and they can only exist under bankruptcy protection, sooner than later.
-
Who’s dumb enough right now to be buying RP debt to finance new acquisitions?
RP can’t retain early to mid career radiologists because of poor pay and horrendous working conditions. RP is in deep danger of being unable to maintain their current contracts when all of their 5 year buyouts finish vesting. They have a lot of fat cat boomers and gen x’ers who don’t need money and want more time off. -
Without billing gimmicks Texas has poor reimbursement. My guess most rural practices collect upper 40s per wrvu. Certainly border practices are in the 40s if not high 30s. RP eagle likely lower. Dallas and Houston and Austin may get to MGMA- 57 wrvu.
-
Specialists playing specialist cards and not reading general cases to hit rvu targets. Lol.
-
Quote from drad123
Without billing gimmicks Texas has poor reimbursement. My guess most rural practices collect upper 40s per wrvu. Certainly border practices are in the 40s if not high 30s. RP eagle likely lower. Dallas and Houston and Austin may get to MGMA- 57 wrvu.
Those RP groups are getting around 30-35 per wRVU with benefits after RP gets their cut with the fraudulent billing (RP skims about 30-40%). No clue how much it’s going to drop with honest contracts. Not looking good for them in the future when Aetna/Cigna/BCBS all decide that they don’t want to play ball with RP either and demand lower rates.
-
I’m in an RP-invested metro and for the most part all of the residents at the programs in the area are on the same page: Do Not Touch. Obviously some residents are completely oblivious to the real world and business etc but we collectively discuss RP so frequently that even the most indifferent residents know to at least feel out some of the other employed gigs in the area before considering that shitshow. There have been a couple of former fellows that I can think of who took RP jobs and lasted less than a year, even giving back substantial signing bonuses to leave. When former co-residents are coming back to tell everyone about how awful it is, people listen. Young rads may be naive but we aren’t [i]that[/i] ignorant. Genie is out of the bottle and it gives me hope that this PE crap crumbles (at least in our metro). When RP’s recruiting pool essentially does NOT include the local residency programs containing a high percentage of people who actually want to stay here long term I cannot fathom how they are going to remain staffed barring a major downturn in the job market. RP was very close to obtaining a high enough local market share to effectively force young rads to take their jobs to stay in the area, but just not quite enough (thank God). And now all those former partners are leaving in droves. At least locally RP seems to be imploding. Hope they lose this lawsuit and go under. Good riddance.
-
EL SEGUNDO, Calif., April 19, 2023–(BUSINESS WIRE)–Radiology Partners (RP), the largest physician-led and physician-owned radiology practice in the U.S., successfully marked its 10th anniversary in 2022 with continued growth. Last year, RP expanded into 155 new sites of service and celebrated 500 new radiologists joining the practice. RP now serves clients in all 50 states and is partnered with 17 of the 20 largest health systems in the country.
-
Last year
Last gasp. -
Meh. Added 2 rads practices and created 7 new ones. Not exactly breakneck growth. And what does created 7 new ones mean? Probably means they were completely crap contracts with crap payer mix and terrible hospital administration. And now they have to recruit for or retain rads at these sites paying them 400-500k a year with large volumes and low vacation. Well see how much they grow next year.
-
I dont understand the economics. How would Rich and Gabby become wealthier if RP dies? Please elaborate. thx
-
UnitedHealth is the largest company in Minnesota and among the 10 largest U.S. public companies.
Why should they pay physicians 80% of fee schedule? UHC just want to pay docs Medicare rates and skim difference.
Skim seems to be a recurring theme in healthcare.
Lets stop the steal. Medicare for all. -
It sounds like fraud. And with governmental money as well.
-
United wouldnt go after them unless they had a strong case and thought they would likely win.
-
Time to pay the piper.
Other private payors will jump on board.
Then you got the Medicare and DOJ/OIG to worry about.
-
[link]https://www.tdi.texas.gov/company/top40.html[/link]
United number 2 in Texas, 12% market share -
So if a RP group in Texas loses 12% of their business overnight… that’s lights out. No way they survive. WTF is RP’s plan here? It’s not a 12% drop in income per rad… they’re probably gonna lose 25-50% since that 12% is probably all of their profit sharing pool net expenses.
-
I know to take online reviews with a grain of salt, but all of those Google reviews are terrible for Rad Partners. It sounds like they are scamming people left and right and committing outright fraud even if a fraction of the overwhelmingly negative reviews are true.
-
Yes. Those reviews are pretty disturbing. They are not like typical negative reviews of people who are unsatisfied about minor things. These patients seem to legitimately have been scammed by RP.
-
I guess the docs who took equity for their “buyouts” are thinking they were real sharp cookies right about now! One silver lining — lots of those rads who thought they would retire early and ride off into the sunset will be sticking around a LOT longer than they initially planned. This will help ease the shortage of rads a bit.
-
Quote from rads4meplease
Check out their google reviews. Theyve been scamming for years.
Radiology Partners Phoenix
[link]https://maps.app.goo.gl/8i4XrDrXHDTuDRUX6?g_st=ic[/link]WTF As low as it gets.
-
-
-
-
-
-
-
-
-
