Subcommittee advances Health Care Transparency and Fraud Prevention Act amid provider concerns

The insurance subcommittee voted to advance House Bill 2170, the Health Care Transparency and Fraud Prevention Act, to the full committee after a lengthy presentation by sponsor Representative Travis and testimony both opposing and supporting the measure.

Representative Travis described the bill as four coordinated parts — the Patient Financial Act, the Health Care Billing Integrity Act, the Pharmaceutical Pricing Transparency Act and related provisions — intended to "give patients the right to clear bills and more time to respond to billing disputes," ensure patients are billed only for care they receive, require disclosures about providers and corporate owners, and make prescription processing clearer for consumers. "The Health Care Transparency and Fraud Prevention Act supports common sense health care protections that puts patients first," the sponsor told the panel.

Physician groups told the committee they oppose the bill as drafted. John Carr, assistant director of government affairs for the Tennessee Medical Association, said the legislation "imposes sweeping regulatory burdens on physicians and medical practices that will undermine patient care and increase health care costs in Tennessee." He listed three principal concerns: new civil-penalty exposure without clear standards, interference with physicians' independent clinical judgment, and disclosure and reporting mandates that would raise administrative costs for small practices.

Julie Griffin of the Tennessee Medical Association added that the bill "piles on potential state disciplinary actions" that mirror federal rules and could double enforcement avenues against providers. Witnesses noted an amendment removed some original civil penalties, but said the bill still could allow complaints that trigger state-level discipline of a medical license.

Representatives and committee members pressed both sides on specifics. Members asked how insurers would determine "upcoding" and what proof would be required before a claim is flagged; Blue Cross witness Russell Marty said potential upcoding is identified when diagnosis codes and billed procedures are inconsistent, and that flagged claims are reviewed by a human clinician before any action. The bill defines "systemic upcoding" as five or more violations in a 12-month period, and the sponsor said penalties in the amended bill are discretionary and tied to human review to avoid punishing honest mistakes.

Blue Cross Blue Shield of Tennessee supported the bill. "We think it's consistent with the intent" of other transparency reforms and that the bill seeks disclosures rather than prohibitions, Russell Marty told the committee. He told members the proposal does not create direct conflicts with existing PBM-related legislation and emphasizes pattern-based enforcement.

After questions and discussion, the chair opened the final vote and announced, "The bill passes." House Bill 2170 was advanced to the full insurance committee for further consideration.

Next steps: HB 2170 will be scheduled for deliberation in the full insurance committee; committee staff and sponsors may consider the technical amendments discussed by members and witnesses.