UnitedHealthcare is suing emergency care supplier TeamHealth, alleging the corporate intentionally and systematically tricked the well being insurer into paying greater than $100 million in fraudulent claims.
The lawsuit, filed within the U.S. District Court docket for the Jap District of Tennessee on Wednesday, accuses private-equity-owned TeamHealth of violating state and federal legal guidelines governing fraud, insurance coverage regulation and shopper safety by upcoding a whole bunch of hundreds of emergency division payments.
In a single occasion, UnitedHealth Group’s insurance coverage subsidiary alleges TeamHealth clinicians handled a 23-year-old man affected by indigestion after consuming a chili canine by giving him an antacid and sending him residence, the grievance says. However TeamHealth subsequently billed the insurer for $1,712 on the grounds that the affected person required “emergency medical care of significantly excessive complexity below exigent circumstances,” the lawsuit alleges.
UnitedHealthcare reviewed some 46,000 TeamHealth claims and located that roughly 60% ought to have been categorized by lower-level Present Procedural Terminology codes, the grievance says.
TeamHealth CEO Leif Murphy known as the lawsuit is retaliation for a authorized motion his firm took in opposition to the insurer earlier this week, and an instance of what he described as UnitedHealthgroup’s observe of shortchanging suppliers.
Along with misrepresenting the complexity of companies supplied, United Healthcare says TeamHealth collected inappropriately excessive charges by submitting payments for companies supposedly carried out by docs that really had been administered by doctor assistants or nurse practitioners. TeamHealth additionally hid the checklist of medical teams it operates, making it onerous for UnitedHealthcare to acknowledge a sample of overbilling, in response to the grievance.
“As a result of TeamHealth engaged in a delicate type of fraud involving deliberate exaggeration quite than outright fabrication, its fraud was troublesome to detect, examine and make sure,” the lawsuit claims.
The personal fairness agency Blackstone acquired TeamHealth for $6.1 billion in 2017.
Since then, TeamHealth has purchased medical practices and saved them outdoors of insurers’ supplier networks. The corporate presently operates 3,400 emergency medical amenities that make use of 18,000 suppliers, which accounts for 17% of the market, in response to the lawsuit.
As a result of TeamHealth pays its clinicians a flat, hourly charge, suppliers didn’t obtain any the additional income, which Blackstone retains, in response to the insurer. TeamHealth’s centralized billing facilities are additionally in control of assigning CPT codes, leaving physicians at midnight concerning the excessive charge of inflated claims, UnitedHealthcare alleges.
“The particular fraudulent habits at situation on this case is only one piece of this bigger tradition of revenue maximization at any price, which demonstrates the acute lengths to which TeamHealth will go in an effort to pad its backside line,” the grievance says.
UnitedHealthcare seeks an injunction to cease TeamHealth from upcoding sufferers, and calls for reimbursement for compensatory and treble damages, equitable and declaratory aid, pre- and post-judgment curiosity, attorneys and courtroom charges, and another aid the courtroom deems simply and correct. UnitedHealthcare is in search of a jury trial.
UnitedHealth Group and TeamHealth have a historical past of suing one another.
Courts have repeatedly dismissed comparable claims in different jurisdictions, Murphy wrote in an e-mail. UnitedHealthcare’s lawsuit is an try and distract from a case a TeamHealth facility introduced in opposition to the healthcare big Monday, he stated.
“United continues to generate document earnings by downcoding claims and refusing to contemplate the experience of frontline clinicians who make a analysis,” Murphy wrote. “Even throughout a pandemic, United makes use of ways like these to revenue off the backs of emergency medication suppliers who’re on the frontline treating sufferers and risking their very own lives. The underside line is the much less UnitedHealth reimburses, the extra earnings they make.”
