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A Nevada jury just awarded two people $524 million in punitive damages, the largest number for an American case so far this year. The bill will be paid by United Healthcare, whose two subsidiaries, attorneys say, failed to monitor the practices of a doctor.

According to Reuters, the case involves two patients of Dr. Dipak Desai. The two plaintiffs, Bonnie Brunson and Helen Mayer, say that they contracted hepatitis C from unsafe practices used during an endoscopy. Their lawyers argue that their insurer should have known that the physician was unsafe because he was part of the insurer's network.

Indeed, Dr. Desai's clinic was found to be the source of a hepatitis outbreak in 2008, CBS Las Vegas reports. The outbreak required about 50,000 patients to be tested. Witnesses stated that Dr. Desai had an ambivalence about patient safety, speeding through appointments to see 20 patients during a three-hour period. They also stated that he had a reputation for sloppy practices before being awarded a contract to perform colonoscopies. In fact, he, along with a pair of nurse anesthesiologists, is currently on trial for second-degree murder of a colonoscopy patient, as well as fraud charges.

However, according to Bloomberg, the insurance companies said that they had followed protocol in order to determine whether the doctor could be in their HMO network. Their lawyers said that the case would set a dangerous precedent, requiring companies to raise costs and monitor patient procedures, putting them at odds with privacy regulations. They also argued that they had been sufficiently punished with an earlier ruling that awarded $24 million to the two former patients and one of their spouses.

The defense of the insurance companies was hurt when the judge refused to let them show evidence that their administrators had not uncovered any proof of wrongdoing in the doctor's office or that the administrators had followed accepted practices.

The award is considered to be a warning to insurance companies that they need to make sure that their customers receive adequate care. However, it falls well short of what attorney had requested: $2.4 billion, which would make up 15 percent of the company's revenues from premiums over the subsequent 10 years, if they increased that revenue by three times. The company said that such an award would cripple the company.

Dr. Desai had previously been a member of the Nevada Board of Medical Examiners, which looks over the licensing of doctors in the state.

The company is seeking to reverse the ruling.