BlueCross Seeking To Recover $4.5 Million In Overpayments To Perry Community Hospital

Insurer's Audit Team Discovered Suspicious Claims Activities Beginning In Mid-2018

Tuesday, December 3, 2019

BlueCross BlueShield of Tennessee on Wednesday 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.”


Health Department Services During The COVID-19 Response Announced

Cempa Community Care To Offer Free Drive-Thru COVID-19 Testing In Chattanooga And East Ridge Aug. 4-5

Welcome Home Of Chattanooga Offers Online Sessions On Compassion For Homelessness


The Hamilton County Health Department continues to limit all regular services in order to respond to the COVID-19 pandemic, yet wants to make the public aware of the services they can still receive. ... (click for more)

Cempa Community Care will offer free drive-thru COVID-19 Testing in Chattanooga and East Ridge this week. Chattanooga testing will be held at Redemption to the Nations Church, 1908 Bailey ... (click for more)

Welcome Home of Chattanooga has partnered with two organizations to present online sessions in August. Officials said, "We are grateful for the National Health Care for the Homeless Council, ... (click for more)



Living Well

Health Department Services During The COVID-19 Response Announced

The Hamilton County Health Department continues to limit all regular services in order to respond to the COVID-19 pandemic, yet wants to make the public aware of the services they can still receive. “This limitation is temporary and we apologize for any inconvenience this may cause,” said Health Department Administrator Becky Barnes, “We hope our residents understand that slowing ... (click for more)

Cempa Community Care To Offer Free Drive-Thru COVID-19 Testing In Chattanooga And East Ridge Aug. 4-5

Cempa Community Care will offer free drive-thru COVID-19 Testing in Chattanooga and East Ridge this week. Chattanooga testing will be held at Redemption to the Nations Church, 1908 Bailey Ave. in Chattanooga on Tuesday from 3-6 p.m. East Ridge testing will be held at Brainerd Baptist Church – East Ridge Campus, 1203 Blocker Lane in Chattanooga, on Wednesday from 3-6 p.m. ... (click for more)

Breaking News

Supt. Johnson Says County Schools To Start Aug. 12 In Groups, But Hope To Be Fully Open By Aug. 30

Hamilton County Schools Supt. Dr. Bryan Johnson on Monday said the schools plan to open Aug. 12 with two groups of students at each school each attending two days a week. However, he said it is hoped that students will be able to go five days a week by Aug. 30. The opening format includes Group A going on Wednesday, Aug. 12, and Group B on Thursday, Aug. 13. Friday will be ... (click for more)

Hamilton County Has Just 52 New Coronavirus Cases, But ICU Cases Continue To Go Up; Tennessee Has 25 More Deaths

Hamilton County had just 52 new coronavirus cases on Monday and deaths remained at 48. However, the number of COVID patients in Intensive Care continued to go up and is now at 37. Total cases now are 5,669 after the numbers have dropped in recent days. There are 86 COVID patients hospitalized as well as four more suspected cases. The number of active cases in Hamilton ... (click for more)

Opinion

Leave C.E. James Monument And Park Alone - And Response (4)

The recent controversy over the monument to our town's founder, C.E. James, is more than a completely unnecessary and avoidable waste of time and possibly money - it is contrived and downright silly. Race-based restrictions on residential real estate sales weren't just common a century ago, they were universal in both the North and South. Such "red-lining" didn't start to die out ... (click for more)

Roy Exum: We’re Out Of ‘Touch’

I’ve been a “people person” for all of my life and not until this past weekend did I become aware I have been suffering badly due to “lack of touch.” A lifelong friend passed along a Daily Devotional where a gifted pastor in Massachusetts mourned the fact that – get this – she had been touched by another human being only four times in the last four months. As I paused to dwell on ... (click for more)