TeamHealth filed suit in federal court on Wednesday alleging that UnitedHealthcare wrongly denied and underpaid for services its emergency physicians provided to patients in Nevada.
Fremont Emergency Services, a TeamHealth subsidiary, alleges that the nation's largest private insurer’s actions violate federal law. Fremont is asking a federal judge in Nevada for a permanent injunction to stop UnitedHealthcare's policy.
The lawsuit alleges that UnitedHealthcare did not pay the Fremont physicians after treating an infant with a traumatic brain injury and a child with a ruptured appendix.
It also alleges that UnitedHealthcare uses an algorithm to routinely delay and deny claims based on certain diagnosis codes.
A UnitedHealthcare spokesperson said the company is still reviewing yesterday’s filing.
This is not the first time TeamHealth has sued UnitedHealthcare.
In December, a Nevada jury ruled in favor of TeamHealth, ordering UnitedHealthcare to pay $60 million in damages following allegations of underpayment for emergency care.
UnitedHealthcare filed its own suit against TeamHealth last year in federal court, alleging that the physician group routinely upcodes, or submits claims with higher codes than the care that was actually provided. Higher codes result in higher payments to providers from insurers.
A federal judge in the Eastern District of Tennessee allowed UnitedHealthcare to proceed with its case, denying TeamHealth's motion to dismiss on May 10, according to docket filings.