BCBS of Tennessee threatens to sue data firm over report finding provider overcharges

An analytics firm that found Tennessee's State Group Insurance Program is overcharging providers may face a lawsuit from the state's largest health insurer. 

BlueCross BlueShield of Tennessee attorneys sent private data firm ClaimInformatics a letter warning that the insurer is contemplating suing ClaimInformatics over a report that found the Tennessee health insurance program approved $17.6 million in provider overcharges. The insurance program contracts with BCBS of Tennessee and Cigna to administer the plan. 

According to the Times Free Press, the information presented in the report remains under a temporary restraining order. A federal judge issued the restraining order in December in response to legal complaints, the report said. BCBS of Tennessee and Cigna filed the restraining order against a state representative who was seeking the firms' claims data, arguing it contained proprietary pricing data.

In addition to the provider overcharges, the firm found state and local government workers and retirees overpaid the program $1.3 million. A total of 5.2 million claims dated from 2017 to 2019 were examined. The primary causes of the overcharges were inaccurate and incorrect coding, the report said. 

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