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.”

Source: UnitedHealth lawsuit claims TeamHealth upcoded claims for $100M in fraud / Fierce Healthcare

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