On December 5, 2013, Judge Stefan Underhill of the U.S. District Court for the District of Connecticut issued a temporary restraining order and preliminary injunction against various United Healthcare (“United”) entities that had terminated approximately 2,200 Connecticut physicians as participating physicians in United’s Medicare Advantage program.  After a number of its members received termination letters, the Fairfield County and Hartford County Medical Associations filed an emergency motion for a temporary restraining order and preliminary injunction seeking to:  (1) enjoin United from terminating any of the affected physicians from United’s Medicare Advantage network; (2) enjoin United from notifying its Medicare Advantage customers that certain physician members would be terminated from the Medicare Advantage network as of February 1, 2014; (3) compel United to reinstate, advertise, and market the affected physicians in their 2014 directories for the Medicare Advantage network. 

The court found that the physicians who were subject to termination would suffer (1) disruption of their relationships with their Medicare Advantage patients; (2) loss of goodwill and reputational harm, and (3) a resulting loss of the ability to compete in the market for the provision of Medicare services.  The court also found that the plaintiffs were likely to prevail on their breach of contract claims, in that United’s argument that it had a unilateral right to terminate a participating physician by “amending” the United Medicare Advantage Plan was not supported by the language of the contract or the parties’ actual experience under it.  Based on these factors, the court entered a preliminary injunction to prevent the removal of affected physicians from United’s Medicare Advantage network pending a determination on the merits of the claims filed by the Medical Associations.

There have been a number of physicians terminated from Medicare Advantage Plans in New Jersey.  In some cases, physicians have received termination letters from United Health Care.  However, we have heard anecdotal evidence that other physicians have heard about the terminations not from United Health Care, but from patients who were notified of the termination during the Medicare Advantage Open Enrollment period (which has already closed).  The preliminary injunction issued against the United Healthcare entities is only effective in Connecticut.  To the extent a physician in New Jersey has received notice of their termination from participation in United Healthcare’s Medicare Advantage plans, or has otherwise heard of such termination, anecdotally, they should consider reviewing their existing United Healthcare Medicare Advantage contracts with legal counsel to determine whether or not it would be appropriate to appeal from the United Healthcare determination (or otherwise contact United Healthcare regarding information received from patients regarding the physician’s termination).