UnitedHealthcare, TeamHealth Settle $100M Upcoding Lawsuit
UnitedHealthcare and TeamHealth voluntarily dismissed with prejudice a lawsuit in which the insurer had accused the physician staffing company of upcoding emergency department claims. The dismissal, filed September 24 in Tennessee federal court, followed the parties notifying the court on August 11 that they had reached a settlement. Terms of the settlement were not disclosed in available court records. While the case involved commercial claims rather than Medicaid specifically, the underlying upcoding allegations against a major ED staffing firm are relevant to program integrity efforts across payers, including Medicaid managed care plans that contract with or reimburse similar staffing arrangements.
Health plans and state Medicaid program integrity units should note that upcoding allegations against large physician staffing firms can be resolved through settlement, underscoring the value of claims audit and coding compliance programs across all payer types.
Managed Care
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