$17.6M in provider overcharges approved by Tennessee health insurance program

Third-party administrators of a Tennessee health insurance program approved at least $17.6 million in provider overcharges, according to the Chattanooga Times Free Press

Private data firm ClaimInformatics identified the overcharges in an internal review of $748 million claim payments from Tennessee’s State Group Insurance Program. The insurance program contracts with BlueCross BlueShield of Tennessee and Cigna to administer the plan. 

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. 

ClaimInformatics didn’t look into whether hospitals overpaid the state insurance program, but may do so in a full audit of claims that is being pursued by Tennessee Attorney General Herbert Slatery and Comptroller Justin Wilson. 

State insurance officials, BCBSTN and Cigna are reviewing the preliminary findings, which they say need to be validated and vetted, according to the Chattanooga Times Free Press.

Read more here.

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