In a newly filed lawsuit, UnitedHealthcare is again suing Radiology Partners (RP), alleging the private equity-backed radiology group is manipulating the No Surprises Act’s (NSA) independent dispute resolution (IDR) process for windfall payments it does not deserve.
The complaint, filed in U.S. District Court for the District of Arizona on August 8 by UnitedHealthcare Services, UnitedHealthcare Insurance Company, and UMR, spotlights Sonoran Radiology and its presence in Arizona. Calling it a “sham out-of-network entity” created by Radiology Partners to initiate improper NSA IDR proceedings, the lawsuit alleges RP has been receiving reimbursements sometimes exceeding 1,000% of Medicare rates.
As in other lawsuits, this complaint implicates the practice of pass-through billing. It alleges RP funneled legitimate in-network claims through Sonoran, making them appear out-of-network and thus eligible for higher payments.
“Radiology Partners alone accounts for over 90% of all IDR cases involving claims for professional radiology services,” the filing states, highlighting that United and its employer customers have paid over $24 million in administrative fees alone related to “ineligible IDR disputes” initiated by Radiology Partners since January 1, 2022.
Sonoran, limited in scope to Arizona, ranks among the nation’s top IDR-initiating parties, the complaint noted. Furthermore, as RP and Sonoran started to obtain more NSA awards in their favor, Sonoran increased its billed charges to eventually nearly 1,600% of Medicare reimbursement rates, according to the suit.
“This systematic abuse of the NSA IDR process is not only egregious but unprecedented, threatening the very integrity of the protections Congress intended to create,” the filing states.
The scheme even escalated, the lawsuit alleged, by RP initiating IDRs on false “out-of-network” services to obtain even greater payments, far in excess of what is reasonable or affordable, according to the filing. The groups that actually performed the services had already agreed to lower contracted rates, according to United, while Sonoran Radiology held no contract.
In total, Radiology Partners used Sonoran to improperly bill United for services performed by 714 physicians affiliated with groups that had existing in-network agreements with United, according to the filing.
“Despite Congress’s intention that in-network rates be a key factor in setting fair out-of-network rates, Radiology Partners-affiliated practices are regularly receiving awards of more than 600% of median in-network rates, for services that are not even eligible for the NSA’s IDR,” the filing stated.
The result of this scheme has been an increase in costs for radiology services all across the state of Arizona, according to United, which is pressing for fraud, negligent misrepresentation and omission, civil conspiracy, unjust enrichment, conspiracy to violate the Arizona Racketeer Influenced and Corrupt Organizations (RICO) Act, and aiding and abetting a tort.
In an email to AuntMinnie, Radiology Partners said that it firmly denies the allegations in the lawsuit.
“This is yet another example of a broader and troubling trend: When payors lose in the federal No Surprises Act arbitration process, they turn to litigation,” they said in the statement. “UnitedHealthcare’s complaint misrepresents the facts and distracts attention from its repeated failures to pay healthcare professionals despite federal protections. RP-affiliated practices follow federal guidelines and have consistently prevailed in the independent dispute resolution process, underscoring the validity of our claims.”
“We remain focused on delivering high-quality radiology care and supporting our radiologists, clients, and patients. RP will vigorously defend against these claims and continue advocating for fair, lawful reimbursement practices that protect patients’ access to care. We look forward to presenting the full facts in our formal court filing.“
RP further noted that “… the federally mandated NSA process is already costly, we find it shameful that we are forced to waste additional healthcare resources relitigating the same matters.”
This isn’t the first time Radiology Partners and UnitedHealthcare have tangled. A similar lawsuit was filed in California in 2023.
More recently, Aetna, part of CVS Health, also alleged fraudulent arbitrations under the NSA independent dispute resolution process.
Review the entire complaint here.