Louisiana Municipal Danger Administration Company filed swimsuit within the Jap District of Tennessee on Monday towards defendants Crew Well being Holdings, Inc., Ameriteam Providers, LLC, HCFS Well being Care Monetary Providers, LLC, and ACS Main Care Physicians Louisiana PC. The swimsuit alleges that the defendants had been part of a scheme which “systematically overbilled each governmental and personal insurance coverage and self-funded payors” just like the plaintiff.
Defendant Crew Well being Holdings, Inc. and defendant Ameriteam Providers, LLC are stated to “personal and management the system of affiliated entities working as and collectively referred to herein as TeamHealth.” TeamHealth is a contractor at varied hospitals the place they supply staffing, operation, and billing companies.
The plaintiff is an administrator of a “self-funded insurance coverage plan to cowl medical bills of staff of police departments, hearth departments, ambulance and different vital native companies.” Crew Well being often gives enrollees of the Plaintiff’s self-funded well being plan with therapy, after which they invoice the plaintiff in keeping with sure codes.
The criticism explains that the TeamHealth group applied systematic overcharges throughout their system and to the plaintiff as part of a bigger scheme. The deliberate enterprise mannequin was purportedly orchestrated in a means that made the overbilling undetectable by conventional audit metrics.
Defendant TeamHealth allegedly used “improperly chosen Present Procedural Terminology (CPT) codes at the side of the billing.” The defendant had beforehand represented to the plaintiff that the codes had been true, correct, and full. TeamHealth was “upcoding” their CPT codes, charging the plaintiff for increased ranges of care when it was not applicable nor supplied.
The criticism 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 equally located plans cumulatively of thousands and thousands of {dollars}.” Because of the defendant’s alleged improper and damaging healthcare billing practices, the plaintiffs are in search of class certification, favorable judgment on all counts, financial damages, equitable and injunctive reduction, litigation charges, pre- and post-judgment curiosity, and some other reduction deemed simply by the courtroom.
The plaintiff is represented by Parker & Crofford, Wallace & Graham, Varnell and Warwick, and Lemmon Regulation Agency, LLC.