UnitedHealthcare, one of the nation’s largest insurers, filed a lawsuit against Envision Healthcare alleging it overpaid the physician staffing firm millions of dollars after Envision exaggerated the complexity of illness and care provided to thousands of patients in emergency rooms.
UnitedHealthcare alleged Envision, one of the largest physician staffing firms in the U.S., has “systematically deceived” the insurer into overpaying through a practice known in the industry as “upcoding,” according to a lawsuit filed in a federal court in Tennessee on Friday.
Envision declined to comment as it evaluates UnitedHealthcare’s claims, a spokesperson told Healthcare Dive.
However, Envision filed a lawsuit of its own last week in the same federal court, alleging UnitedHealthcare wrongly denied payment for emergency room services provided by Envision’s clinicians.
In one instance, UnitedHealthcare denied payment for a 31-year-old man’s emergency appendectomy and care for a baby with unexplained episodes of choking, vomiting and turning blue, Envision alleged.
UnitedHealthcare and Envision have not had an in-network contract since January 2021. Since the termination of that contract, Envision has upcoded claims, resulting in UnitedHealthcare overpaying, according to the lawsuit.
“The upcoded claims falsely stated that Envision’s physicians rendered the most extensive treatment ... when they in reality had in fact treated routine health problems, such as food poisoning, anxiety, or the flu,” UnitedHealthcare alleged in its lawsuit.
UnitedHealthcare is also facing a separate lawsuit from a different physician staffing firm.
In July, TeamHealth filed suit alleging the insurer wrongly denied and underpaid for services its emergency physicians provided to patients in Nevada.