Buncombe County files suit alleging over-billing at several WNC emergency dept. facilities
By Charles Perez
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BUNCOMBE COUNTY, North Carolina (WLOS) — Buncombe County has filed a class-action lawsuit against a Tennessee company that is responsible for billing at numerous Western North Carolina healthcare facilities.
The company, TeamHealth, contracts with hospitals, clinics and doctors to bill for medical services. According to the suit, filed on Nov. 22 in Nashville, the county is alleging the company engaged in a deliberate and deceptive practice of over-billing for emergency department services.
At the center of the allegations is the practice of coding patients once they are admitted. When patients are admitted, they are given a code, designating their status, with a higher code number meaning the patient’s condition is more serious.
In 2021, Buncombe County conducted an investigation into the practice and discovered that 60% of all admissions in centers served by TeamHealth, were coded as Level 5, the highest and most serious level.
According to Buncombe County, as cited in the lawsuit, that number is greatly inflated and likely intended to allow TeamHealth to bill patients for services above and beyond what they required. The practice is known as up-coding, and, as alleged by Buncombe County, is part of a deliberate effort to boost profits.
TeamHealth issued a statement responding to the allegations, saying, “TeamHealth emphatically disagrees with the allegations made by Buncombe County… TeamHealth uses professional coders subject to extensive auditing.”
Western North Carolina medical facilities served by TeamHealth include:
Mission Hospital in Asheville Haywood Regional Medical in Clyde Rutherford Regional Medical Center Mission Hospital McDowell in Marion
The class-action lawsuit filed by Buncombe County is on behalf of the approximately 1,500 employees on the county’s health plan. The county took the action after paying out more than 900 claims for reimbursement.
Buncombe requested supporting documents from TeamHealth justifying the charges, and TeamHealth responded, refusing to deliver the requested materials.
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