Buncombe County's lawsuit advances: Overbilling allegations against TeamHealth upheld
Wednesday, January 17, 2024 | | Author: Jennifer Emert | Original Article
ASHEVILLE, N.C. (WLOS) — There have been new developments in Buncombe County's lawsuit against TeamHealth, the billing service for HCA's Mission Hospital.
NEW DEVELOPMENTS
On Wednesday, Jan. 17, U.S. District Judge Clifton Corker upheld Buncombe County’s allegations of overbilling and proved enough facts to demonstrate a RICO enterprise, meaning TeamHealth knew the billing codes used for medical services were inflated.
TeamHealth had moved to strike the class action allegations, but the court also denied that motion. Mona Lisa Wallace, of Wallace and Graham, P.A., is co-counsel for the county.
“We are very happy to proceed with the next steps in this case," she said.
In an 18-page Memorandum Order, the judge denied TeamHealth’s motion to dismiss the case, allowing the case to move to its next stage, which will allow attorneys to question TeamHealth managers.
TeamHealth is physician-founded, physician-led clinician networks providing medical services to communities in need. It does not conduct billing and collections operations, a spokesperson said.
BACKGROUND
On Nov. 22, 2022, Buncombe County brought a lawsuit against medical staffing giant TeamHealth Holdings of Knoxville, Tennessee. The company is owned by Blackstone and provides medical billing services for HCA’s Mission Hospital in Buncombe County.
The lawsuit alleges that TeamHealth inflated the billing codes used to bill charges for medical services to the Buncombe County Government Group Health Plan. According to Buncombe County, it alleges it overpaid based on those bills.
The county claims TeamHealth sent bills that used improper “CPT Codes,” for example, using a Level 5 code where only a Level 4 was warranted. Codes are typically ranked in levels from Level 1 to Level 5, with Level 1 being the least expensive. According to the county, by paying the inflated bills the county alleges its health plan was overcharged.
According to the lawsuit to verify the allegations of the scheme, Buncombe County hired a coding expert who reviewed medical bills for five clients. In each of the five examples, “the CPT code used was higher than the service provided warranted.” Because of that, Buncombe County paid 1.5 to 2.5 times more than if the bill was coded with what it considered to be the proper code.
In a release from Wallace and Graham P.A. they explained, “In addition to alleging its own claim, the County in its lawsuit seeks to represent a class of all other likewise affected plans and payors in the United States. TeamHealth moved to strike the class action allegations. However, the Court denied the motion to strike.”
Former North Carolina Appellate Judge Robert A. Hunter, of Higgins Benjamin PLLC, represents the county in the matter. He stated, "We are pleased the court has ruled in this case and will get to work on discovery in the case."
“We are very happy to proceed with the next steps in this case,” Wallace stated.
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TeamHealth issued the following statement about the ruling:
We see this latest court ruling as nothing more than a procedural step, and in no way changes TeamHealth’s continued position that this lawsuit is frivolous and without merit. Buncombe County’s campaign attacks clinicians who provide top-quality care to the citizens of Buncombe County when they are the most vulnerable 24/7, 365 days a year. We continue to stand by them and the care they provide with upmost integrity." Click Here to View the Court Document