Buncombe County has filed a class-action lawsuit against a Tennessee company that is responsible for billing at numerous Western North Carolina healthcare facilities.
The company, TeamHealth, contracts with hospitals, clinics and doctors to bill for medical services. According to the suit, filed on Nov. 22 in Nashville, the county is alleging the company engaged in a deliberate and deceptive practice of over-billing for emergency department services.
At the center of the allegations is the practice of coding patients once they are admitted. When patients are admitted, they are given a code, designating their status, with a higher code number meaning the patient’s condition is more serious.
In 2021, Buncombe County conducted an investigation into the practice and discovered that 60% of all admissions in centers served by TeamHealth, were coded as Level 5, the highest and most serious level.
According to Buncombe County, as cited in the lawsuit, that number is greatly inflated and likely intended to allow TeamHealth to bill patients for services above and beyond what they required. The practice is known as up-coding, and, as alleged by Buncombe County, is part of a deliberate effort to boost profits.
TeamHealth issued a statement responding to the allegations, saying, "TeamHealth emphatically disagrees with the allegations made by Buncombe County... TeamHealth uses professional coders subject to extensive auditing.”
Western North Carolina medical facilities served by TeamHealth include:
- Mission Hospital in Asheville
- Haywood Regional Medical in Clyde
- Rutherford Regional Medical Center
- Mission Hospital McDowell in Marion
The class-action lawsuit filed by Buncombe County is on behalf of the approximately 1,500 employees on the county’s health plan. The county took the action after paying out more than 900 claims for reimbursement.
Buncombe requested supporting documents from TeamHealth justifying the charges, and TeamHealth responded, refusing to deliver the requested materials.
Full statement by TeamHealth:
TeamHealth emphatically disagrees with the allegations made by Buncombe County. The same lawyers made the same allegations in their lawsuit on behalf of Gerry Wood Automotive when TeamHealth clinicians had never treated a single Gerry Wood Automotive employee. That case was dismissed. The same lawyers made the same allegations on behalf of Louisiana Risk Management Agency, whose lawsuit was also dismissed last week. We are confident that the Buncombe County complaint will meet a similar and definitive fate. TeamHealth uses professional coders subject to extensive auditing through its compliance program. TeamHealth’s coding results closely align with national and regional patterns published by CMS. It is to be expected that the acuity level of patients treated in hospital emergency departments is higher than the acuity level of those treated in convenient care centers and physician offices. TeamHealth is proud that our clinicians have selflessly provided life-saving care to the largest hospital emergency departments in Buncombe County, including Mission Hospital, the region’s only trauma center, throughout the pandemic. Our clinicians have done this with the utmost integrity.