UnitedHealth lawsuit claims TeamHealth upcoded claims for $100M in fraud

UnitedHealthcare has filed suit against physician staffing firm TeamHealth, alleging the company upcoded for services to the tune of $100 million.

The suit, filed Wednesday in Tennessee federal district court, claims the company purposefully upcoded for tens, if not hundreds, of thousands of medical claims. As one of the largest emergency department staffing companies in the country, TeamHealth has significant clout to drive up costs, according to the complaint.

TeamHealth also manages billing and coding for the physician groups it contracts with, UnitedHealthcare said in the suit.

"It is TeamHealth’s coders who decide which codes to utilize, applying TeamHealth’s policies. It is TeamHealth that submits claims to insurance companies under the names of its affiliated or acquired medical groups," according to the lawsuit. "And it is TeamHealth—not the medical groups or the doctors or other providers—that keeps the profits from its fraudulent billing."

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TeamHealth CEO Leif Murphy said in a statement to Fierce Healthcare that the courts "have repeatedly dismissed these claims in other jurisdictions."

Instead, Murphy said the lawsuit is meant as a distraction from one filed by one of its affiliate medical groups in Nevada over underpayments.

"United continues to generate record profits by downcoding claims and refusing to consider the expertise of front-line clinicians who make a diagnosis. Even during a pandemic, United utilizes tactics like these to profit off the backs of emergency medicine providers who are on the front line treating patients and risking their own lives," Murphy said. "The bottom line is the less UnitedHealth reimburses, the more profits they make.” 

TeamHealth and UnitedHealthcare have been embroiled in an ongoing feud, including lawsuits flung back and forth. In November 2020, emergency doctors filed suit against UnitedHealthcare's parent company UnitedHealth Group and provider network management firm Multiplan, alleging the two withheld payments from them.

TeamHealth also filed suit against the country's largest insurer when it cut certain out-of-network reimbursements by 50%.

In the latest lawsuit, UnitedHealth alleges that TeamHealth ramped up its "aggressive pursuit of profit" in the wake of its acquisition by Blackstone in 2017.

"The United Plaintiffs have recently discovered that TeamHealth’s tactics have crossed the line from aggressive profit maximization to fraud," they said in the lawsuit.

UnitedHealthcare also engaged in similarly heated contract negotiations with Envision, a rival physician staffing firm, before cutting the company from its network at the beginning of this year.