Insurer’s audit team discovered suspicious claims activities beginning in mid-2018
CHATTANOOGA, Tenn. — BlueCross BlueShield of Tennessee on last Wednesday (11/27) filed a demand for arbitration against Perry Community Hospital to recover more than $4.5 million in overpayments due to improper billing practices.
Perry Community Hospital has served as a partner in the BlueCross provider network since 1996. Several months after the Linden, Tenn., hospital was purchased in 2018, BlueCross began to identify questionable medical claims for laboratory services, resulting in an audit.
BlueCross audited Perry Hospital’s claims for 2018. The audit showed that in August, the hospital began miscoding claims – and submitting an increased number of claims for lab services for BlueCross members who had not been patients of Perry Hospital. It’s estimated that BlueCross – on behalf of its customers – overpaid Perry Community Hospital by as much as $4.7 million due to these improper billing practices.
BlueCross notified hospital officials of the overpayment and provided an opportunity for them to appeal the determination. To date, Perry Community Hospital has neither appealed nor voluntarily repaid the funds. Therefore, BlueCross has taken steps to recover the money owed to the company.
“Hospital billing practices is an issue that has garnered recent media attention across the state – especially in rural facilities,” said Scott Pierce, EVP and Chief Operating Officer for BlueCross. “We continue to actively monitor for such practices and will act accordingly, when necessary, to make sure those we are privileged to serve get the value and benefit that we’re paying for on their behalf.”
BlueCross BlueShield of Tennessee’s mission is to provide peace of mind through better health. Founded in 1945, the Chattanooga-based company is focused on serving more than 3.5 million members in Tennessee and across the country. BlueCross BlueShield of Tennessee Inc. is an independent licensee of the BlueCross BlueShield Association. For more information, visit the company’s website at bcbst.com.