Ballad Health Files Lawsuit Against UnitedHealth Group
GREENVILLE, Tenn. — Ballad Health has initiated legal action against UnitedHealth Group in federal court in Greenville.
The healthcare system argues that UnitedHealth “systematically denies, delays, or underpays treatment deemed medically necessary by doctors,” while also inflating the severity of its members’ illnesses to secure higher payments from taxpayers through the Medicare Advantage program.
This marks the first time Ballad has taken an insurance company to court.
News 5 has contacted UnitedHealth Group for comments and will provide updates if a response is received.
In their full statement, Ballad Health explained the situation:
They have filed a federal lawsuit against one of the largest health insurers in the U.S. This action stems from frustrations over years of unresolved payment and patient service issues. Ballad Health aims to safeguard the interests of patients, doctors, and hospitals in the Appalachian Plateau.
Alan Levine, chairman and CEO of Ballad Health, shared that “legal action was a last resort.” He expressed that this was not a preferred option but a necessary step due to the adverse effects of UnitedHealth’s practices on patient care and community hospitals.
Anthony Argyropoulos, who represents Ballad in this case, emphasized their long-standing commitment to patient care and equitable treatment for healthcare providers. Unfortunately, he noted that UnitedHealth’s approach hinders access to care in rural zones, forcing systems like Ballad Health to take a stand.
Ballad Health mostly serves rural populations where over 75% of patients rely on government healthcare programs or have no insurance. About 55% of their patients are covered by Medicare, with nearly three-quarters enrolled in Medicare Advantage plans, primarily from UnitedHealth.
According to Argyropoulos, when a major insurer like Medicare Advantage manipulates healthcare dynamics, it threatens access to care for seniors in rural areas. Such practices can lead to longer hospital stays, delayed discharges, and added pressure on hospital resources—all detrimental to patient health.
Ballad Health has expressed concerns that UnitedHealth’s denial of necessary post-acute care can prolong hospitalizations, potentially raising the risk of infections and escalating costs for both patients and hospitals.
Armed with the understanding that UnitedHealth has agreed to reimburse for long-term care but has not followed through, Argyropoulos noted that the company is withholding millions in owed payments.
The lawsuit also references a nationwide report alleging that UnitedHealth subsidiaries acquire physician practices and employ aggressive coding tactics to maximize Medicare payments, while pushing providers to increase patient numbers and limit medical expenses.
Argyropoulos criticized the federal government for denying necessary care to these patients, arguing that such actions further compound health issues and burden the communities these programs intend to support.
Furthermore, Ballad Health has stated that their Medicare Advantage contract with UnitedHealth will not be renewed when it expires on June 30, 2027. This decision pertains solely to that contract, while Ballad will still engage with UnitedHealth concerning commercial, Medicaid, and exchange insurance policies.
Levine highlighted the unsustainable nature of such contracts for rural healthcare systems, asserting, “Our mission is simple: Keep care local, keep hospitals open, and ensure access to the professionals and services you need.”
