The lawsuit, filed Oct. 27 in Tennessee federal court, alleges TeamHealth upcoded claims. UnitedHealthcare analyzed ER claims and records from TeamHealth and found 62 percent of the claims involving the highest-paying emergency department codes — CPT codes 99285 and 99284 — were not supported by the medical records, the complaint alleges.
UnitedHealthcare claims that TeamHealth deliberately upcoded the claims to deceive the insurance company into overpaying for ED services “and to reap windfall profits.”
UnitedHealthcare estimates that it has overpaid $100 million on claims submitted by TeamHealth since 2016.
TeamHealth CEO Leif Murphy called the lawsuit frivolous and noted that similar claims have been dismissed in other jurisdictions. UnitedHealthcare’s case is an effort to take attention away from a lawsuit a TeamHealth affiliate is pursuing against the insurer for alleged underpayments, Mr. Murphy said.
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