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A federal judge has brushed aside an effort by an emergency room services group to make UnitedHealthcare show how emergency room services practices in its own corporate family handle billing.
UnitedHealthcare — a subsidiary of UnitedHealth Group — has been suing TeamHealth, a company that represents about 18,000 physicians and helps staff hospital emergency rooms.
Optum Health, another UnitedHealth Group subsidiary, owns a minority stake in Sound Physicians, a physician staffing firm.
U.S. Magistrate Judge Debra Poplin ruled last month that UnitedHealth has walled UnitedHealthcare off from Sound Physicians.
UnitedHealthcare cannot get Sound Physician billing records simply because Optum has access to anonymized Sound Physicians patient records through the de-identified Normative Health Information database, or dNHI database, according to Poplin's opinion and order.
"The court finds that plaintiffs' ability to access the dNHI database, which is used primarily for academic research, is not dispositive of whether they also have possession, custody, or control over Optum's medical group documents," Poplin wrote.
Poplin is helping to preside over the case in the U.S. District Court for the Eastern District of Tennessee.
U.S. District Judge Clifton Corker, another judge in the district, ruled against another TeamHealth request for access to Sound Physicians records in November and suggested that the request looked like a "fishing expedition."
UnitedHealthcare has sued TeamHealth in connection with allegations of "upcoding," or efforts to adjust medical billing codes to make them look more intense and more expensive than they really should be.
UnitedHealthcare contends that TeamHealth has made overly heavy use of Current Procedural Technology code 99285, which is supposed to be used for cases in which a patient is "at imminent risk of death or loss of physiological function," in place of less intense emergency services codes, such as CPT codes 99281, 99282, 99283 and 99284.
UnitedHealthcare and TeamHealth are now sparring over what data the parties must provide and how.
What it means: If the Tennesee ruling stands, UnitedHealth Group may feel more secure about letting Optum continue to run the dNHI database. This could help the researchers and health cost analysts who use the database in their work.
The ruling could also affect how easily providers and other parties can get access to records in other cases involving members of UnitedHealth Group and other large health insurance and health care services organizations.
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