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A federal judge has ruled in favor of UnitedHealthcare in connection with litigation over how TeamHealth, a large group medical practice, bills for emergency medical services.
U.S. District Judge Clifton Corker denied TeamHealth's request to see the billing records for an emergency medical practice with ties to UnitedHealthcare's corporate family, according to an opinion and order posted Tuesday.
Corker agreed with UnitedHealthcare that how a medical practice in its corporate family bills health insurers is irrelevant to the dispute over how TeamHealth billed UnitedHealthcare.
"This is precisely the kind of 'fishing expedition' district courts have discretion to limit," Corker wrote in the opinion explaining the ruling.
UnitedHealthcare and TeamHealth were not immediately available to comment on the ruling.
What it means: The TeamHealth case might not give employers and their benefits advisors a chance to see how a medical practice affiliated with Optum handles its billing.
The parties: UnitedHealthcare, a health insurer, and Optum Health, a health care deliver business, are both subsidiaries of UnitedHealth Group. Optum Health owns a minority stake in Sound Physician, a physician staffing firm.
TeamHealth represents =18,000 physicians. Blackstone, a private equity firm, owns a stake in the firm.
The case: UnitedHealthcare has sued TeamHealth in the U.S. District Court for the Eastern District of Tennessee in connection with allegations that the practice violated federal laws, including federal racketeering laws, by systematically "upcoding" medical bills.
UnitedHealthcare says TeamHealth used billing codes that made the services provided for the patients look more intense than they really were.
TeamHealth has denied the allegations.
TeamHealth filed a motion asking asking the court to make UnitedHealthcare provide Sound Physician records, in an effort to determine whether TeamHealth and Sound Physician have been using similar claim coding strategies.
UnitedHealthcare told the court that the Sound Physician records have no bearing on the TeamHealth case.
Optum owns only a minority stake in Sound Physician, and UnitedHealthcare and Optum are separate enough that, in many cases, when UnitedHealthcare has not hired Optum to provide certain services, UnitedHealthcare must file a subpoena to get records from Optum, according to a response UnitedHealthcare filed in October.
A magistrate judge who is helping to manage the case ruled against TeamHealth, and Corker said in the opinion that he agrees with her reasoning.
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