The Tennessee Medical Association (TMA) and two Nashville physicians have filed legal action in Davidson County Chancery Court relating to letters sent by Health Research Insights, Inc. (HRI), to a large number of Nashville physicians. The letters allege incorrect billing for medical services performed in 2006 and 2007. The physicians deny they were overpaid and allege that HRI’s assertions of overpayment, made without even reviewing the medical records, are baseless and defamatory.

 

HRI is a “recovery contractor” that was hired by Metropolitan Board of Public Education (MBPE) to recover alleged overpayments by Blue Cross Blue Shield of Tennessee (BCBST), the third party administrator for MBPE’s health benefit plan. BCBST has not asserted that the physicians were overpaid, and has denied any connection with HRI.

 

HRI sent letters to a large number of physicians, accusing them of billing incorrectly and demanding the physicians send money or confidential medical records relating to the treatment provided. HRI contends that its actions are not subject to contract terms and state laws prohibiting such late allegations of overpayment, or made directly by MBPE rather than BCBST. Physicians who did not respond to the letters were subjected to high-pressure telephone collection efforts by HRI employees.

 

“This is about protecting our patients’ private health information and fair treatment for physicians,” said TMA President Richard J. DePersio, MD. “Our members complained to us about the HRI ‘strong-arm’ letters. We had to act because we cannot tolerate business practices that ignore state law and contracts, threaten patient privacy, and make false accusations of physician fraud. The threats and intimidation tactics used by HRI were a catalyst for our actions.”

 

The lawsuit, filed June 12, asserts that HRI caused MBPE to breach its contract with BCBST; violated the State Consumer Protection Act by engaging in unfair or deceptive business practices toward the physicians; and sought to obtain private patient information through misrepresentation. The suit alleges MBPE contracted with HRI to recover overpayments even though MBPE had previously assigned matters relating to overpayment recovery to BCBST.

 

“HRI’s actions were an attempt to circumvent state law and contracts involving BCBST, MBPE, and the physicians, which set forth how and when any questions regarding overpayment to network physicians are to be handled,” said Dr. DePersio.

 

The lawsuit asserts alternatively that if BCBST did not have the authority to contract on behalf of MBPE as it represented, and MNPE can circumvent the terms of the BCBST/Physician Agreement, then discounts given to MBPE pursuant to the BCBST/Physician Agreement should be refunded.

 

The lawsuit seeks an injunction and a declaratory judgment to stop the HRI tactics in violation of state laws and MBPE contracts, and monetary damages for defamation and for expenses incurred by physicians accused of overbilling. The lawsuit was filed by attorney David L. Steed of Cornelius & Collins, LLP, on behalf of the TMA and the individual physicians.