TennCare’s Largest MCO Faces Lawsuits, State’s Threat to Terminate Contract
Amid "threat[s]" by state officials to terminate its TennCare contract, Access MedPLUS, the state's largest TennCare plan, is being sued by the Tennessee Medical Association, the Nashville Tennessean reports. In a lawsuit filed on Oct. 8, the TMA alleges that Access MedPLUS has "attempted to excuse itself from paying just debts by unilaterally crediting their records ... for amounts that they assert were overpaid to providers." TMA is seeking a temporary restraining order against the MCO to prevent the company from "recouping" alleged overpayments and to require the company to "pay the amounts that have been withheld." State officials indicated that they are investigating the physicians' complaints. An Access MedPLUS spokesperson declined to comment about the suit.
More Problems for MedPLUS
Meanwhile, state officials have said they will terminate the Access MedPLUS TennCare contract on Oct. 31, 2001, if the MCO is unable to prove its financial solvency. State officials had given the MCO until Oct. 9 to file financial reports and "other information," but said it would "take several days" to determine whether that information sufficiently proves the company's financial status. Access MedPlus has been under state supervision since May 2000 because of its failure to pay providers "accurately or on time." In June, all 16 hospitals in HCA Inc.'s MidAmerica division left the Access MedPLUS network, citing "problems that went 'uncorrected.'" Another hospital, Gateway Medical Center, will drop out of the Access MedPLUS network on Oct. 31, citing "multiple problems." Last week, the Genisys Group, a technology consulting firm, sued the operator of Access MedPLUS, Medical Care Management Co., for "refusing to pay" for computer consulting services (Snyder, Nashville Tennessean, 10/10). For further information on state health policy in Tennessee, visit State Health Facts Online.
