Louisiana Insurance Company Sues Over Alleged Overbilling

Louisiana Municipal Risk Management Agency filed suit in the Eastern District of Tennessee on Monday against defendants Team Health Holdings, Inc., Ameriteam Services, LLC, HCFS Health Care Financial Services, LLC, and ACS Primary Care Physicians Louisiana PC. The suit alleges that the defendants were a part of a scheme which “systematically overbilled both governmental and private insurance and self-funded payors” like the plaintiff.

Defendant Team Health Holdings, Inc. and defendant Ameriteam Services, LLC are said to “own and control the system of affiliated entities operating as and collectively referred to herein as TeamHealth.” TeamHealth is a contractor at various hospitals where they provide staffing, operation, and billing services.

The plaintiff is an administrator of a “self-funded insurance plan to cover medical expenses of employees of police departments, fire departments, ambulance and other important local services.” Team Health regularly provides enrollees of the Plaintiff’s self-funded health plan with treatment, after which they bill the plaintiff according to certain codes.

The complaint explains that the TeamHealth organization implemented systematic overcharges across their system and to the plaintiff as a part of a larger scheme. The deliberate business model was purportedly orchestrated in a way that made the overbilling undetectable by traditional audit metrics.

Defendant TeamHealth allegedly used “improperly chosen Current Procedural Terminology (CPT) codes in conjunction with the billing.” The defendant had previously represented to the plaintiff that the codes were true, accurate, and complete. TeamHealth was “upcoding” their CPT codes, charging the plaintiff for higher levels of care when it was not appropriate nor provided.

The complaint cites a violation of the Racketeer Influenced and Corrupt Organizations Act (RICO), conspiracy to violate RICO, and unjust enrichment. The plaintiff contends that “the scheme defrauded the Plaintiff and similarly situated plans cumulatively of millions of dollars.” As a result of the defendant’s alleged improper and damaging healthcare billing practices, the plaintiffs are seeking class certification, favorable judgment on all counts, monetary damages, equitable and injunctive relief, litigation fees, pre- and post-judgment interest, and any other relief deemed just by the court.

The plaintiff is represented by Parker & Crofford, Wallace & Graham, Varnell and Warwick, and Lemmon Law Firm, LLC.