UnitedHealth exec’s court testimony hints at MultiPlan trouble

UnitedHealthcare, meanwhile, sued TeamHealth in the U.S. District Court for the Eastern District of Tennessee in late October, saying the emergency room group deliberately and systematically tricked the health insurer into paying more than $100 million in fraudulent claims.

TeamHealth did not provide a response by deadline.

UnitedHealthcare did not respond to an interview request.

UnitedHealthcare does not comment on its outside partners and contracts, MultiPlan wrote in a letter to shareholders on Monday.

“Clients still wanted to use the wrap networks, the prospective fee negotiations that MultiPlan provides, and we were willing to accommodate that,” Haben told the court. “We’re not going to force a client to move.”

In 2023, UnitedHealthcare had planned to transition its self-funded customers from MultiPlan to an in-house program that it estimated would save it more than $300 million in annual vendor fees, according to an internal document from the insurer that TeamHealth submitted as evidence to the court. UnitedHealthcare is still seeking redactions of some evidence, and the court has ordered that document not be made public until the judge rules on whether surfacing the slide is relevant to the case.

But the documents partially confirm the claims made in a short-seller report last year that MultiPlan vehemently denies. The report alleged that UnitedHealthcare—MultiPlan’s largest customer—was phasing the company out of its service line. The report speculated that UnitedHealthcare represented a third of MultiPlan’s total business.

It came months after Multiplan went public as an $11 billion special-purpose acquisition company, with some analysts questioning whether the deal represented an actual growth opportunity or solved a looming bond maturity problem faced by MultiPlan. When the report was released, the company also faced questions about how it would remain relevant once the No Surprises Act goes into effect in 2022.

MultiPlan has said it plans to grow by investing in new business lines and targeting payers beyond traditional insurers. Others argue that MultiPlan’s services offer a “legal shield” to insurers, allowing them to blame their low rates on the vendor rather than their own decisions.

MultiPlan continues to deny the short-seller report, saying that, over the past three years, its revenue from UnitedHealthcare has grown more than 30% and that the two companies have a partnership that MultiPlan expects to grow beyond 2022.

“The false claim that UHC was terminating its relationship with MultiPlan was perpetuated by short sellers, motivated by their own economic self-interest,” MultiPlan wrote in a letter to shareholders Monday.

But many investors believe UnitedHealthcare is developing an in-house alternative to MultiPlan. A June policy document from UnitedHealthcare describes Naviguard as its “lead out-of-network offering” for employers to resolve disputes with providers.

Naviguard was not developed to replace MultiPlan and currently offers a different suite of services, according to Haben, who said he managed UnitedHealthcare’s relationship with MultiPlan.

Naviguard is an internal customer advocacy tool that helps members understand their benefits, steer patients to in-network providers and address any out-of-pocket expenses, Haben described. MultiPlan offers a network of provider agreements, negotiation services, outlier cost management and fraud and waste prevention tools, he added.

Haben did not immediately respond to an interview request.

“The UHC “termination” rumor has been used by opportunistic short sellers to profit by driving down MultiPlan’s stock and other securities,” MultiPlan wrote to stockholders Monday morning.

This isn’t the first time the company’s management has addressed its relationship with UnitedHealthcare.

In July, MultiPlan said that it does not expect a UnitedHealthcare policy change to have a “material impact” on its finances for 2021.

That month, UnitedHealthcare enacted a program to no longer pay out-of-network claims when fully insured customers seek non-emergency care outside their local coverage area. A week after news of UnitedHealthcare’s updated guidelines went public, MultiPlan’s stock price dove 25%.