Fairview sues UnitedHealthcare over false advertising

Minneapolis-based Fairview Health Services is suing UnitedHealthcare, alleging the nation's largest health insurer is falsely advertising its 2027 Medicare Advantage plans by including Fairview hospitals and clinics in its network.

The lawsuit, filed in federal court in Minnesota, comes after Fairview chose not to renew its contract with UnitedHealthcare in June. Fairview claims that UnitedHealthcare is misleading Medicare Advantage customers by suggesting that the health system will remain part of its network in 2027.

"Fairview's current patients and Medicare beneficiaries shopping for coverage (mostly Minnesota seniors) will be confused about whether Fairview is in-network with UHC and they could lose their chance to choose a different plan for 2027 that allows them to see providers at Fairview during the annual enrollment period," the complaint said.

The court filing stated that Fairview is not currently in negotiations with the insurer and does not expect to reopen discussions.

In a statement to MPR News, UnitedHealthcare wrote that they are actively collaborating with Fairview in "good faith" to reach a mutually affordable agreement, while also maintaining long-term access for the health system's members. If an agreement cannot be reached, UnitedHealthcare said members will be notified about the possibility of Fairview going out of network, following the guidelines set by the Centers for Medicare and Medicaid services.

According to the complaint, Fairview has encountered difficulties in its dealings with UnitedHealthcare MA plans for years, citing payment delays, low reimbursement rates, prior authorization challenges, and payment denials.

The dispute came to a head in September, when Fairview asked UnitedHealthcare to confirm that the health system would not be listed in provider directories for 2027, according to the lawsuit. Fairview said UnitedHealthcare appeared surprised by the request and could not provide an answer. Fairview then requested written confirmation that same day. In the days that followed, Fairview's legal team sent UnitedHealthcare a notice stating that the health system would not participate in the insurer's MA plans in 2027.

But UnitedHealthcare's annual notice of change directed enrollees to an online provider directory that, according to the lawsuit, continued to list Fairview as an in-network provider for 2027.

"The notice also tells members that if they do not select another plan, their enrollment will continue automatically," a Fairview spokesperson said in a statement. "Fairview argues that leaving inaccurate network information in place as annual enrollment begins could have significant consequences for Minnesota seniors. Patients may select or renew UnitedHealthcare coverage believing they will continue to have access to Fairview, only to learn later that Fairview will be out of network in 2027."

Fairview estimates that about 33,000 of its current patients are enrolled in UnitedHealthcare MA plans each year.

The health system is seeking several forms of relief, including a temporary restraining order before Medicare's annual enrollment period begins on October 15. Fairview is asking the court to require UnitedHealthcare to correct its network information and turn over profits it earns from Fairview patients who enroll in its MA plans for 2027. It is also seeking compensatory damages for costs associated with outreach to Medicare patients.

The lawsuit does not affect Fairview's separate commercial health insurance agreement with UnitedHealthcare. Patients who have UnitedHealthcare's insurance coverage through their employer will continue to have in-network access to Fairview in 2027.

Fairview said it has been communicating directly with patients about the Medicare Advantage change and providing resources to help them understand their coverage options ahead of annual enrollment, which runs from Oct. 15 through Dec. 7.

"We are asking the court to require accurate information before enrollment begins, when patients still have the opportunity to make an informed choice," said Dr. Jaya Kumar, Fairview's chief medical officer, in a statement.

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