TeamHealth sues UnitedHealthcare over downcoding as the companies' legal spat continues

TeamHealth has fired the lastest salvo in its lengthy war with UnitedHealthcare, with one of its subsidiaries filing suit Wednesday against the insurer over downcoding

Fremont Emergency Services, one of the largest emergency medicine groups in Nevada, filed a lawsuit in Las Vegas federal court, seeking an injunction against the insurer's downcoding policy. Fremont said that the downcoding "arbitrarily" decreases payments to emergency clinicians who have provided care to UHC members.

For example, Fremont alleges that UnitedHealthcare denied the claim for emergency care provided to a baby with a severe head injury. The clinicians were later "significantly underpaid" for the claim because the insurer determined that the patient's condition was not serious, Fremont alleges in the lawsuit.

“Despite having faced sanction, jury awards and settlement payments of some half a billion dollars, United persists in exploiting vulnerable patients and refusing to adequately pay providers,” said Scott Scherr, M.D., medical director at Fremont in a statement. “This filing would never happen were it not for United’s ongoing, extensive wrongdoing that puts their billions in profits ahead of patients’ well-being and the needs of the U.S. healthcare system.”

A spokesperson at UnitedHealthcare told Fierce Healthcare that the company is still reviewing the lawsuit.

In December, a Nevada jury awarded TeamHealth $60 million in punitive damages after determining that the insurer underpaid emergency physicians at three of its subsidiaries in the state. Other similar lawsuits are pending in multiple states.

TeamHealth claims in the new suit that the December ruling does not appear to have changed the company's behavior.

"Notwithstanding this and other sanctions, United’s misconduct remains undeterred," the company said in the suit.

Tennessee federal courts mark another front in the two companies' ongoing legal battle, with UnitedHealthcare filing suit against TeamHealth, alleging that the physician staffing firm upcoded for tens, if not hundreds, of thousands of claims to the tune of $100 million.

In May, a federal judge denied TeamHealth's request to dismiss the Tennessee lawsuit.