UnitedHealthcare sues TeamHealth | Modern Healthcare

UnitedHealth Group sued TeamHealth on Wednesday, alleging the non-public equity-owned group of emergency room suppliers intentionally and systematically tricked the healthcare large into paying greater than $100 million in fraudulent affected person claims.

The go well with, filed within the U.S. District Courtroom for the Jap District of Tennessee, alleges TeamHealth violated state and federal legal guidelines round fraud, insurance coverage regulation and client protections round unjust enrichment by upcoding lots of of hundreds of emergency room payments.

In a single occasion, TeamHealth clinicians handled a 23-year-old affected person affected by indigestion after consuming a chili canine by giving him an antacid and sending him residence, the grievance says. The invoice supplied to UnitedHealthcare, nevertheless, stated the person required “emergency medical care of notably excessive complexity beneath exigent circumstances,” and charged the insurer $1,712. UnitedHealthcare stated it reviewed some 46,000 business claims and located that roughly 60% ought to have utilized lower-level CPT codes.

Along with misrepresenting the complexity of companies supplied, TeamHealth additionally falsely billed UnitedHealthcare for companies carried out by nurse practitioners or physicians assistants, saying docs who command a better fee have been offering the care, the lawsuit says. The corporate additionally hid the checklist of medical teams it operated, making it arduous for UnitedHealthcare to acknowledge its sample of overbilling, in accordance with the grievance.

“As a result of TeamHealth engaged in a delicate type of fraud involving deliberate exaggeration fairly than outright fabrication, its fraud was tough to detect, examine, and ensure,” the go well with says.

Personal fairness agency Blackstone purchased TeamHealth for $6.1 billion in 2017.

Since then, the corporate has been centered on shopping for up medical practices and staying out-of-network with insurers. TeamHealth blocks its medical practices from contracting straight with payers, and calls for independence from its in-network hospitals’ insurance coverage contracts, the go well with says. The corporate at the moment operates 3,400 emergency medical services that make use of 18,000 suppliers nationwide, representing 17% of the whole market, in accordance with the go well with.

As a result of TeamHealth pays its physicians a flat, hourly fee, suppliers don’t obtain any of the additional income pocketed by the non-public equity-owned group. The corporate’s centralized billing facilities are additionally in command of assigning sufferers CPT codes, leaving physicians at nighttime in regards to the excessive fee of inaccurate insurance coverage claims submitted, the go well with says.

“The precise fraudulent habits at challenge 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 to be able to pad its backside line,” the go well with says.

UnitedHealthcare seeks an injunction to cease TeamHealth from upcoding affected person circumstances, in addition to reimbursement for compensatory and treble damages, equitable and declaratory reduction, pre- and post-judgment curiosity, attorneys and court docket charges and another reduction the court docket deems simply and correct. UnitedHealthcare is searching for a jury trial.

UnitedHealth Group and TeamHealth have a historical past of suing one another.

Courts have repeatedly dismissed comparable claims in different jurisdictions, TeamHealth CEO Leif Murphy wrote in an electronic mail. Leif stated UnitedHealthcare’s lawsuit was an try and distract from a case a TeamHealth facility introduced in opposition to the healthcare large, and which began Monday.

“United continues to generate file income by down coding claims and refusing to think about the experience of frontline clinicians who make a prognosis,” Leif wrote in an electronic mail. “Even throughout a pandemic, United makes use of techniques 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 income they make.”

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