UnitedHealthcare sues Radiology Partners over billing dispute

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UnitedHealthcare is suing Radiology Partners (RP), claiming that the imaging services provider has engaged in a pass-through billing scheme that has resulted in tens of millions of dollars in allegedly fraudulent payments.

The complaint, filed in the U.S. District Court for the Central District of California on April 14 by UnitedHealthcare of Texas and UnitedHealthcare Services, centers on Singleton Associates, an RP-affiliated radiology practice in Houston that had a longstanding contract with United prior to its affiliation with RP. That contract, which was signed in 1998, granted Singleton Associates "particularly high reimbursement rates," to practice at two hospitals in Houston, United said.

However, after Singleton became affiliated with RP in 2014, United claims that RP "directed and conspired with Singleton to engage in a fraudulent pass-through billing scheme to deceive United" by submitting claims for services performed by what United deemed to be "unauthorized providers." Many of these providers were located outside of Houston, and in some cases, even outside of Texas, according to United.

"... Radiology Partners caused Singleton to bill United for services that Singleton did not perform in order to give Radiology Partners' other affiliated medical groups access to the high reimbursement rates provided in United's nearly 25-year-old contract with Singleton," United said in its complaint.

United claims that RP breached Singleton's contract, which explicitly provides for reimbursement only for services provided by a "Medical Group Physician," a term defined as a person with a Medical Degree or Doctor of Osteopathic Medicine degree who practices as a shareholder, partner, or employee of Singleton and who has executed a "Medical Group Physician Participation Addendum."

The contract also prohibited Singleton from assigning its rights and responsibilities without written consent from United, according to the insurer.

However, after the affiliation began in 2014, RP caused Singleton to begin adding "unauthorized providers" who weren't affiliated with Singleton "but, instead, were affiliated with other medical groups that were controlled by Radiology Partners," United claimed in the complaint.

"They were not employees, shareholders, or partners of Singleton and were not providing services to Singleton's patients (i.e., at hospitals where Singleton was previously contracted to provide radiology services)," United said in the complaint. "Indeed, many of the radiologists added to the Agreement starting in 2015 were employed by medical groups other than Singleton. Many of these groups had separate arrangements with Radiology Partners. And many of these other medical groups, that actually employed the providers Singleton was adding, had separate network contracts with United."

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.

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.

The full complaint can be found here.

An RP spokesperson said that the claims in the complaint are without merit.

"We believe UHC's complaint represents an obvious attempt to delay or disrupt the conclusion of an underpayment dispute currently in arbitration involving a Texas-based RP-affiliated practice," the spokesperson told AuntMinnie.com. "We stand by the integrity of RP and our affiliated practices."

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