Ballad Health files lawsuit against United Health

GREENEVILLE, Tenn. — Ballad Health has filed a federal lawsuit against UnitedHealth Group, one of the nation's largest health insurers.

The Johnson City-based health care 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, according to written statement.

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.

"Taking legal action was our last resort," said Alan Levine, chairman and CEO of Ballad Health. "This is not our first choice; it's not a choice we've had to make before. But we had to take action because we believe UnitedHealth's behaviors are so harmful to patients, doctors and community hospitals."

"Ballad Health has worked in good faith for years to ensure patients receive the care they need and that providers are treated fairly," added Anthony Argiropoulos, of Baker Donelson, who represents Ballad Health in the lawsuit. "Unfortunately, UnitedHealth's 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."

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's patients are covered by Medicare, and nearly three-quarters of those are enrolled in Medicare Advantage plans – most with UnitedHealth.

Ballad Health said UnitedHealth's 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 costing patients and hospitals more money.

"UnitedHealth 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," added Argiropoulos. "However, the company has failed to honor that commitment and has withheld millions of dollars it agreed to pay."