The Louisiana Municipal Risk Management Agency claims that the private-equity-backed physician staffing firm used a “fraudulent and intentionally obfuscated scheme” in emergency room overcharges to its workers. According to the lawsuit, TeamHealth, a contractor at various hospitals where they provide staffing, operation, and billing services, frequently billed for services rendered by physicians when they were performed by a physician assistant and it overbilled 81 percent of its claims, mostly by using inflated Current Procedural Terminology (CPT) codes, also known as upcoding, appropriate for higher levels of care. Further, the lawsuit claims that TeamHealth’s central billing office is "controlled in a cartel-like manner".
TeamHealth told Becker's Hospital Review that this lawsuit is “almost identical to a frivolous lawsuit filed by the same attorneys last year which was quickly dismissed” and that the firm “engages professional coders who follow CMS and American Medical Association guidelines for coding emergency medicine claims…coding is subject to a rigorous quality assurance process both internally and externally and is consistent with nationally published database averages."
According to court documents, TeamHealth regularly provides enrollees of the Risk Management Agency’s self-funded health plan with treatment, after which they bill the plaintiff according to certain codes. However, along with Ameriteam Services, LLC, HCFS Health Care Financial Services, LLC, and ACS Primary Care Physicians Louisiana PC., the defendants were a part of a scheme which “systematically overbilled both governmental and private insurance and self-funded payors. Team Health and Ameriteam Services own and control the system of affiliated entities operating as and collectively referred to herein as TeamHealth.
The Louisina lawsuit includes every self-funded payer that has paid for TeamHealth's services over the last four years. It was filed on March 22, 2022, just days before a $15 million settlement between another group of ER doctors and their employer was announced.
TeamHealth Physician Settlement
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According to Bloomberg Law, Judge W. Keith Watkins said the settlement “appears to be the result of arm’s length negotiations by highly experienced and knowledgeable class counsel and to be fair, reasonable, and adequate.” The class consists of emergency room doctors working anywhere in the U.S. who participated in Team Health’s incentive program, whether as a Team Health employee or independent contractor, the order says. Ddoctors working in “pool” or “tiered” where incentive payments were at the company’s sole discretion are not included.