Former TN Legislator Calls Health Insurance Audit “Waste” of Taxpayer Money

Image Credit: MartinDanielTN

The Tennessee Conservative [By Jason Vaughn] –

A former Tennessee legislator says the state is wasting more taxpayer money in their attempt to recoup overages from payments for state employee health insurance.

Martin Daniel, a former state representative from Knoxville, has been pushing the state for years to review the finances of the state’s health plan. After an investigation, it has been shown that taxpayers have been overcharged up to tens of millions of dollars over the past three years.

According to Daniel, state monitors have done little to step in when it comes to these overpayments.

“For example, we would see on one hand where a colonoscopy would cost in one place $800 and in another place $16,000. Of course, that’s at the taxpayers’ expense,” Daniel alleged.

Both BlueCross BlueShield and Cigna provide services for the state’s employee health insurance, which pays as much as $600 million worth of claims each year. Approximately 146,000 current and retired state employees have access to this program.

The state’s response to this discovery was to request an audit that Daniel says is a “waste.”

“It appears to be a waste of taxpayers’ money,” Daniel said. “We got a half-done audit. And it tells us very little.”

A partial audit was done by Claim Informatics in 2020 after Daniel raised concerns. Approximately five million claims filed between 2017 and 2019 were reviewed, and it was determined that nearly $17 million worth of money was spent on erroneous payments. Another $22 million worth of claims were “suspicious” and it was recommended that they be reviewed further.

The new audit did not go back and look for those overpayments, leaving the state unable to go after that money. Former Tennessee Attorney General Herbert Slatery’s office hired a different company for the second audit and asked them to only review information from 2020.

The 2020 audit only found $268,770 in overpayments to BCBS and $1,398,893 to Cigna. Both companies deny that they received erroneous reimbursements.

The state spent nearly $175,000 for the new audit. The attorney general’s office said an audit going back to 2017 to recoup the additional money would cost $490,000. They say they asked the new company to use the “most recent and comprehensive” data that was available.

Healthcare Horizons, the company responsible for the updated audit, released the following statement:

“Healthcare Horizons was engaged by the Tennessee Attorney General’s Office after a national, competitive proposal process. Our engagement was performed as defined in the proposal process and was most thorough.

Healthcare Horizons has performed healthcare claims audits for over 20 years for some of the country’s largest employers and government entities. Our knowledge, experience and accomplishments equal or exceed that of any healthcare claims audit firm as evidenced by our selection by the Tennessee Attorney General’s Office.

In closing, Healthcare Horizons is headquartered in Tennessee and believes the taxpayers of our great state would be pleased to know that over five dollars of recoverable claims were identified for every one dollar spent in audit fees. That reflects our state’s history of excellent financial stewardship.”

About the Author: Jason Vaughn, Media Coordinator for The Tennessee Conservative  ~ Jason previously worked for a legacy publishing company based in Crossville, TN in a variety of roles through his career.  Most recently, he served as Deputy Director for their flagship publication. Prior, he was a freelance journalist writing articles that appeared in the Herald Citizen, the Crossville Chronicle and The Oracle among others.  He graduated from Tennessee Technological University with a Bachelor’s in English-Journalism, with minors in Broadcast Journalism and History.  Contact Jason at news@TennesseeConservativeNews.com