TeamHealth was founded in Knoxville in 1979 by Dr. Lynn Massingale.[4][5] The company began as Southeastern Emergency Physicians, the predecessor to TeamHealth, when Dr. Massingale, then an emergency medicine physician at the University of Tennessee Medical Center, earned the staffing contract in the emergency department at the medical center.[6] Dr. Randal Dabbs, co-founder, began working with Southeastern Emergency Physicians and became a full partner in 1981.[7][8]
In 1983, Dr. John Staley, co-founder, formed Emergency Coverage Corporation, a competitor to Southeastern Emergency Physicians. In 1986, the two companies merged. Over the years, other physicians, Dr. Gar LaSalle, Dr. James Rybak and Dr. Jim George, and their clinical groups joined TeamHealth and are now considered founders of the company.[6]
As of 2015, TeamHealth contracted more than 18,000 health professionals and handled about 10 million emergency room visits per year.[9]:8Leif M. Murphy became chief executive officer and president in 2016.
In 2017, TeamHealth’s clinician recovery team responded to several natural disasters and crisis situations, including Hurricane Harvey in Houston;[10]Hurricane Irma in Florida; the Route 91 Harvest music festival mass shooting in Las Vegas;[11][12][13] the Atlas Peak wildfire in northern California; and Hurricane Maria in Puerto Rico. In each situation, TeamHealth’s clinicians helped local hospitals manage capacity as they were overcrowded with patients.[14]
In September 2019, the NYT revealed that Team Health was one of two companies behind a political action group called "Doctor Patient Unity". The PAC had surfaced in July 2019 and spent more than $28 million in advertising opposing legislation to end out-of-network charges ("surprise medical bills" after emergency room visits). Because it did not disclose staff nor funders it has been referred to as a dark money group.[15][16] In October 2019, TeamHealth CEO Leif Murphy reaffirmed the company’s long-standing policy against balance billing patients and urged Congress to pass a legislative solution to end surprise medical billing that allowed health insurers and providers to work out billing disputes through an independent dispute resolution system.[17][18]
In December 2020, TeamHealth CEO Leif Murphy issued the following statement supporting the No Surprises Act, “We fully support the No Surprises Act, as it is unequivocally the right thing for patients by placing the obligation for fair payment for emergency services on the insurer and keeping the patient out of the middle of any payment dispute.”[19]
In August 2019, Moody's downgraded TeamHealth's bond rating to B3-CFR and B3-PD probability of default citing its dispute with its largest payor source, United Healthcare.[20] United Healthcare alleged that TeamHealth was responsible for egregious billing for services rendered in emergency rooms across the country and announced "it will terminate approximately two-thirds of its in-network contracts with Team Health between October 15, 2019 until July 1, 2020. The company also said that UnitedHealth had significantly reduced its payments to Team Health for out-of-network services."[21]
In June 2020, a district court in Nevada ruled that a lawsuit filed by TeamHealth against United Healthcare could proceed. TeamHealth alleged that United breached its contracts by underpaying claims and worked with Data ISight to artificially reduce payment rates.[22]
In August 2019, a Qui Tam lawsuit was filed on behalf of the US Government alleging systemic billing fraud involving Federal and State payor systems.[23] Following a two-year investigation, the government declined to intervene in the case. The suit was settled and TeamHealth made no admission of wrongdoing.[24]
In November 2019, NPR revealed a billing practice of TeamHealth's of suing poor and unfunded patients.[25] According to a November 2019 letter from CEO Leif Murphy, TeamHealth eliminated the practice of pursuing unpaid bills in court and instituted a proactive discount policy that lowers costs for qualifying patients up to 90 to 100 percent.[26]
According to the company, TeamHealth clinicians are on the frontlines of the COVID-19 pandemic. In April 2020, an image of two married TeamHealth nurse anesthetists embracing in complete personal protective equipment (PPE) at Tampa General Hospital went viral amid the early spread of the COVID-19 pandemic.[27]
TeamHealth affiliates have filed lawsuits against insurers in an attempt to recover underpayments to emergency department physicians.[28] According to the company, these lawsuits are intended to require insurers to uphold their financial commitment to their customers and avoid placing the patient in the middle of a reimbursement dispute between the emergency room providers and the insurance companies.[29]
In July 2020, a jury in the federal court for the Eastern District of Arkansas ruled that a Centene health plan had underpaid Southeastern Emergency Physicians, a TeamHealth affiliate, and awarded $9.4 million in damages.[30] The six-person jury found that Centene and its subsidiaries breached their contract with the TeamHealth affiliate by underpaying the emergency room claims and delaying their reimbursement.[31]
TeamHealth developed and implemented COVID-19 safety protocols nationwide.[32] In November 2020, TeamHealth deployed more than two dozen clinicians to help hospitals and health clinics in El Paso, Texas, as they struggled to manage a massive outbreak of COVID-19.[33]
In June 2021, a Texas jury awarded TeamHealth physicians $19.1 million in damages after finding that Molina Healthcare had refused to pay frontline emergency room doctors.[34] The jury agreed on all counts that Molina Healthcare “engaged in unfair and deceptive practices.”[35]
Litigation Against UnitedHealthcare
In October 2021, TeamHealth began a trial against UnitedHealthcare in the 8th District Court of Clark County, Nevada. TeamHealth alleges that the insurer underpaid claims made by three Nevada-based affiliates by as much as $10.5 million for emergency department care.[36]
According to a statement from the company, “TeamHealth’s case will prove that United was orchestrating this [underpayments] scheme at the expense of frontline healthcare providers and their patients amid a devastating pandemic. Attorneys found that in many cases United was being paid more to process or adjudicate the patient’s claim than the front-line clinicians who provided the emergent care. Compromising the quality of emergency medical care in a natural disaster, a mass casualty event, or in any community is a risk no one can afford. This is why TeamHealth is standing up against United.”[37]
On November 29, 2021, after more than three weeks of testimony and two days of deliberation, the Clark County, Nevada jury found unanimously in favor of TeamHealth that UnitedHealthcare engaged in unfair reimbursement practices by deliberately failing to pay frontline emergency room doctors adequately for care provided to patients.[38]
The jury awarded TeamHealth $2.65 million in compensatory damages after finding UnitedHealthcare "guilty of oppression, fraud, and malice" by clear and convincing evidence. In a separate punitive damages phase, the jury unanimously awarded the provider group $60 million in punitive damages in addition to the compensatory award.[39][40]
In a statement, TeamHealth President & CEO Leif Murphy stated that the company “look[s] forward to continuing the fight against United in nine future cases that will be decided on the same set of facts.” TeamHealth has similar cases pending against United in New Jersey, Pennsylvania, New York, Florida, Oklahoma, and Texas.[41]
In one instance discussed in Nevada court, United reimbursed only $254 for a gunshot wound treatment billed at $1,428, despite testimony from a former United executive calling the total price tag “reasonable” and "worth" the charge for saving a life.[42]
Several days before opening statements began, United filed a lawsuit in Tennessee Federal District Court alleging that TeamHealth up-coded charges.[43] However, courts have repeatedly dismissed these claims in other jurisdictions, including the 8th District Court in Nevada along with courts in Arkansas, Texas, Tennessee, Mississippi, and Georgia.[44][45] According to a statement from TeamHealth, “This frivolous lawsuit is a calculated effort to divert attention away from the court case commencing Monday in Las Vegas.”[46]
Unsealed documents revealed that United HealthCare provided the anonymous data for Yale University economist Zack Cooper’s 2016 study on surprise medical billing, and made editorial suggestions. The National Institute for Health Care Management, whose board of directors is composed of health insurance executives, also provided financial support for Cooper’s work.
The research, presented at the White House, the U.S. Department of Justice, the Federal Trade Commission, and elsewhere, was publicized as a rigorous academic research study.[47] While the lawsuit revealed that the study's anonymous data was provided by United HealthCare, other studies replicated the results using data from other insurance companies.[48] The study's conclusions were used to advance a formula that allows insurance companies to determine payments to out-of-network physicians.[citation needed]
The study was widely cited by both national media outlets and members of Congress and has since heavily impacted the Biden administration’s implementation of the “No Surprises Act.”[49][50]
Leadership
Leif M. Murphy became chief executive officer and president in 2016. Dr. Jody Crane became chief medical officer in 2019. Dr. Lynn Massingale, co-founder, serves as chairman.[51]
Awards and recognition
Co-founder and Chairman Lynn Massingale named 2018 Tennessee Health Care Hall of Fame Inductee.[52]
Health Net, LLC, a subsidiary of Centene, is an American health care insurance provider. Health Net and its subsidiaries provide health plans for individuals, families, businesses and people with Medicare and Medicaid, as well as commercial, small business, and affordable care insurance.
Medical malpractice is professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient, with most cases involving medical error. Claims of medical malpractice, when pursued in US courts, are processed as civil torts. Sometimes an act of medical malpractice will also constitute a criminal act, as in the case of the death of Michael Jackson.
HCA Healthcare, Inc. is an American for-profit operator of health care facilities that was founded in 1968. It is based in Nashville, Tennessee, and, as of May 2020, owned and operated 186 hospitals and approximately 2,400 sites of care, including surgery centers, freestanding emergency rooms, urgent care centers and physician clinics in 20 states and the United Kingdom. As of 2024, HCA Healthcare is ranked #61 on the Fortune 500 rankings of the largest United States corporations by total revenue.
The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care. It has become the predominant system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010.
...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations.
UnitedHealth Group Incorporated is an American multinational health insurance and services company based in Minnetonka, Minnesota. Selling insurance products under UnitedHealthcare, and health care services and care delivery aided by technology and data under Optum, it is the world's eleventh-largest company by revenue and the largest health care company by revenue.
Health care prices in the United States of America describe market and non-market factors that determine pricing, along with possible causes as to why prices are higher than in other countries.
Community Health Systems (CHS) is a Fortune 500 company based in Franklin, Tennessee. It was the largest provider of general hospital healthcare services in the United States in terms of number of acute care facilities. In 2014, CHS had around 200 hospitals, but the number had declined to around 85 in 2021.
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
WellCare Health Plans, Inc. is an American health insurance company that provides managed care services primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug plans for members across the United States.
Centene Corporation is a publicly traded managed care company based in St. Louis, Missouri, which is an intermediary for government-sponsored and privately insured healthcare programs. Centene ranked No. 25 on the 2023 Fortune 500.
Prime Healthcare Services is a United States privately held healthcare company. It was established in 2001, by chairman and CEO Prem Reddy, MD, and operates 44 hospitals in 14 states. It is affiliated with the nonprofit Prime Healthcare Foundation.
Sutter Health is a not-for-profit integrated health delivery system headquartered in Sacramento, California. It operates 24 acute care hospitals and over 200 clinics in Northern California.
An integrated delivery system (IDS), also known as integrated delivery network (IDN), is a health system with a goal of logical integration of the delivery (provision) of health care as opposed to a fragmented system or a disorganized lack of system.
Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance. The United States spends more on healthcare than any other country, both in absolute terms and as a percentage of GDP; however, this expenditure does not necessarily translate into better overall health outcomes compared to other developed nations. Coverage varies widely across the population, with certain groups, such as the elderly and low-income individuals, receiving more comprehensive care through government programs such as Medicaid and Medicare.
Elevance Health, Inc. is an American health insurance provider. Prior to June 2022, Elevance Health was named Anthem, Inc. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Anthem Blue Cross in California, Wellpoint, and Carelon. It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within its affiliated companies' health plans.
Health care fraud includes "snake oil" marketing, health insurance fraud, drug fraud, and medical fraud. Health insurance fraud occurs when a company or an individual defrauds an insurer or government health care program, such as Medicare or equivalent State programs. The manner in which this is done varies, and persons engaging in fraud are always seeking new ways to circumvent the law. Damages from fraud can be recovered by use of the False Claims Act, most commonly under the qui tam provisions which rewards an individual for being a "whistleblower", or relator (law).
Balance billing, sometimes called surprise billing, is a medical bill from a healthcare provider billing a patient for the difference between the total cost of services being charged and the amount the insurance pays. It is a pervasive practice in the United States with providers who are out of network, and therefore not subject to the rates or terms of providers who are in-network. Balance billing has a variable prevalence by market and specialty.
This article summarizes healthcare in California.
Teladoc Health, Inc. is a multinational telemedicine and virtual healthcare company headquartered in the United States. Primary services include telehealth, medical opinions, AI and analytics, telehealth devices and licensable platform services. In particular, Teladoc Health uses telephone and videoconferencing software as well as mobile apps to provide on-demand remote medical care.
Medical outsourcing is a business process used by organizations like hospitals, nursing homes, and healthcare provider practices to obtain physician, nursing, healthcare technician, or other services in a managed services model.
↑ Zack Cooper, Fiona Scott Morton, and Nathan Shekita (July 2017). Surprise! Out-of-Network Billing for Emergency Care in the United States (Report). NATIONAL BUREAU OF ECONOMIC RESEARCH. p.108.{{cite report}}: CS1 maint: multiple names: authors list (link)
This page is based on this Wikipedia article Text is available under the CC BY-SA 4.0 license; additional terms may apply. Images, videos and audio are available under their respective licenses.
US$7.35 Billion (2012)
