BlueCross BlueShield of Tennessee attorney threatens data firm with lawsuit following reports on alleged medical bill overpayments

Aug. 25--NASHVILLE -- Attorneys for BlueCross BlueShield of Tennessee have fired a letter off to a Connecticut-based analytics firm's head, warning that the nonprofit insurer is weighing suing the data firm over its report alleging overpayments to some providers in the state's health plan.

In his letter to ClaimInformatics' president Stephen Carrabba, attorney Robert E. Boston with the Waller Lansden Dortch & Davis law firm wrote that the information remains under a temporary restraining order issued in December by a federal judge in response to legal complaints.

Both Chattanooga-based nonprofit BlueCross Blue Shield and Cigna sought the restraining order against state Rep. Martin Daniel, who was seeking the firms' claims data. Both insurers said it contains proprietary pricing data.

In June, ClaimInformatics issued preliminary findings based on some of the information which had been originally sought by Daniel, R-Knoxville, who has previously raised concerns about aspects of the plan's administration and released the Connecticut firm's preliminary findings.

The firm's two first-blush reports state the company found at least $17.58 million in medical professional provider overcharges approved by third-party administrators BlueCross and Cigna for Tennessee's State Group Insurance Program over a three-year period. That was out of some of $748 million worth of payments on professionals' claims. No wrong-doing was alleged.

(READ MORE: BlueCross BlueShield of Tennessee to make telehealth coverage permanent after expansion amid COVID-19 crisis)

Another $1.3 million in overcharges was paid by state and local government workers as well as retirees enrolled in the state's program, according to ClaimInformatics, which conducted the initial review of payments and billing involving medical professionals such as physicians.

ClaimInformatics' examination and findings came some eight months after BlueCross and Cigna -- the insurers that contract with the state to administer the plan -- filed federal lawsuits to block Tennessee Gov. Bill Lee's administration from releasing their pricing information.

ClaimInformatics' Carrabba did not immediately respond to a Times Free Press email late Monday afternoon.

Daniel, who is co-chairman of the General Assembly's Fiscal Review Committee, also did not respond to a request for comment.

In his Aug. 21 letter to Carrabba, attorney Boston wrote that U.S. District Court Judge Eli Richardson's December order states that the "State Employee Defendants may not disclose Confidential Information pursuant to the pending Open Requests Law request of Representative Daniel (or any subsequent request) until further Order of this Court."

Boston goes on to write BlueCross "believes that ClaimInformatics is in possession of documents, data and materials relevant to the lawsuit that is not available from any other source.

"Therefore, this letter respectfully advises you of the Company's obligations to preserve documents and materials that are relevant to the lawsuit."

The attorney then warns, "this is to inform you that BCBST has reason to believe ClaimInformatics has illegally and tortiously harmed BCBST, and we are currently evaluating options regarding a claim against ClaimInformatics."

Those claims include:

-- A violation of the Defend Trade Secrets Act of 2016 "for knowingly misappropriating the trade secrets of BCBST."

-- "Intentional interference" with BCBST's business relationships.

-- "Libelous statements as to BCBST, including but not limited to holding itself as an auditor of BCBST, falsely authoring that BCBST paid erroneous medical claims, falsely authoring that BCBST's payments exceeded the amount billed and falsely authoring that BCBST improperly coded emergency room visits."

On another front, the attorney said, "We would like to schedule a preliminary discussion without prejudice regarding items #1 and #2 above, and provide ClaimInformatics an opportunity to describe its position before the filing of a lawsuit."

(READ MORE: Best Places to Work: BlueCross BlueShield of Tennessee)

Contact Andy Sher at [email protected] or 615-255-0550. Follow on Twitter @AndySher1.

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