Phyllis T. Craighead v. Bluecross Blueshield Of Tennessee, Inc.

CourtCourt of Appeals of Tennessee
DecidedJuly 31, 2008
DocketM2007-01697-COA-R10-CV
StatusPublished

This text of Phyllis T. Craighead v. Bluecross Blueshield Of Tennessee, Inc. (Phyllis T. Craighead v. Bluecross Blueshield Of Tennessee, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals of Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Phyllis T. Craighead v. Bluecross Blueshield Of Tennessee, Inc., (Tenn. Ct. App. 2008).

Opinion

IN THE COURT OF APPEALS OF TENNESSEE AT NASHVILLE February 6, 2008 Session

PHYLLIS T. CRAIGHEAD v. BLUECROSS BLUESHIELD OF TENNESSEE, INC., ET AL.

Appeal from the Circuit Court for Wilson County No. 12,289 Clara W. Byrd, Judge

No. M2007-01697-COA-R10-CV - Filed July 31, 2008

We reverse the trial court’s finding that the immunity granted in the second sentence of Tenn. Code Ann. § 56-53-110 applied only where there was proof that actual malice was absent. With regard to the statute of limitations governing claims related to diminution in value to a business, where the gravamen of the complaint is for breach of contract, the six-year period of Tenn. Code Ann. § 28-3- 109 governs, but where the gravamen of the complaint is for injury to property, the three-year period of Tenn. Code Ann. § 28-3-105 governs.

Tenn. R. App. P. 10 Extraordinary Appeal; Judgment of the Circuit Court Reversed and Remanded

PATRICIA J. COTTRELL, P.J., M.S., delivered the opinion of the court, in which FRANK G. CLEMENT , JR., and RICHARD H. DINKINS, JJ., joined.

Gary C. Shockley, Samuel T. Bowman, Nashville, Tennessee, for the appellants, BlueCross BlueShield of Tennessee, Inc., and Volunteer State Health Plan, Inc.

Robert E. Cooper, Jr., Attorney General and Reporter, Dennis J. Garvey, Deputy Attorney General, Jeremy E. Pyper, Assistant Attorney General, Nashville, Tennessee, as Amicus Curiae in support of appellants, BlueCross BlueShield of Tennessee, Inc., and Volunteer State Health Plan, Inc.

Robert L. Huskey, Jason L. Huskey, Manchester, Tennessee, for the appellee, Phyllis T. Craighead.

OPINION

This court granted defendant’s Tenn. R. App. P. 10 application for an extraordinary appeal to review the trial court’s denial of defendant’s request for partial summary judgment of plaintiff’s claim for malicious prosecution and to review which statute of limitations applies to a claim pertaining to diminution in value to a business. In July of 2002, Phyllis Craighead, individually and as an assignee of Kids and Nurses, Inc.1 (“K&N”), sued BlueCross BlueShield of Tennessee (“BCBS”)2 for breach of contract, malicious prosecution, and outrageous conduct.

The following facts are not disputed. K&N, as the name implies, provided nursing services for children with special health problems. In May of 1993, K&N entered into a contract with BCBS to provide these services to BCBS enrollees. In February of 1996, the parties entered into an amendment of their contract such that K&N provided the services as a subcontract to BCBS under the TennCare program. The contract between BCBS and K&N gave either party the right to terminate the contract without cause upon 90 days written notice. On September 11, 1997, BCBS gave K&N notice of its intent to terminate the contract which was effective 90 days thereafter.

All parties acknowledge that the contract between BCBS and K&N was subject to the TennCare Contractor Risk Agreement between BCBS and the TennCare Bureau. The Contractor Risk Agreement between BCBS and the State of Tennessee for TennCare services provides in § 1.5 as follows:

All managed care organizations shall immediately report to the TBI MFCU [Tennessee Bureau of Investigation Medicaid Fraud Control Unit] any suspicion or knowledge of fraud and/or abuse, including but not limited to the false or fraudulent filings of claims and/or the acceptance or failure to return monies allowed or paid on claims known to be false or fraudulent. The reporting entity shall not attempt to investigate or resolve the reported suspicion, knowledge or action without informing the TBI MFCU and must cooperate fully in any investigation by the TBI MFCU or subsequent legal action that may result from such an investigation. TennCare managed care organizations and health care providers shall, upon request, make available to the TBI MFCU any and all administrative, financial and medical records relating to the delivery of items or services for which TennCare monies are expended. In addition, the TBI MFCU must be allowed access to the place of business and to all records of any TennCare managed care organization or health care provider during normal business hours, except under special circumstances when after hour admission shall be allowed. Special circumstances shall be determined by the TBI MFCU.

1 It is not disputed for purposes of this appeal that Kids and Nurses, Inc. was sold to Pediatric Services of America on November 21, 1997, including M s. Craighead’s interest in K&N. It appears that Ms. Craighead was assigned by K&N its interest in the lawsuit against BCBS, although the terms and extent of this assignment are neither challenged nor clear. For purposes of this opinion, it is assumed that K&N assigned to M s. Craighead any breach of contract claims K&N may have had against BCBS.

2 Included as defendant were the affiliated companies of BCBS, including Volunteer State Health Plan, Inc. which is a managed care organization that contracted with the State of Tennessee, TennCare Bureau, in the Contractor Risk Agreement to provide services for TennCare, the state’s Medicaid plan. The defendant is collectively referred to as “BCBS.”

-2- In Ms. Craighead’s Response to the defendant’s Rule 56.03 Statement of Undisputed Facts, the parties agreed as follows:

2. BCBS was under a contractual duty to report suspected fraud to the TBI.

Source: Contractor Risk Agreement § 1-5.

Response: Admit, but this requirement to admit does not give them the license to misrepresent the facts to TBI for BlueCross’s financial gain.

3. BCBS was under a contractual duty to cooperate with the TBI in its investigation of suspected fraud.

Source: Deposition of Patricia Schermerhorn, page 107, lines 1-19;

Response: Admit

In her complaint, Ms. Craighead alleges that BCBS wrongfully reported accepted billing practices as Medicaid fraud to the Tennessee Bureau of Investigation (“TBI”) which prompted a criminal investigation and that during the course of the criminal investigation BCBS provided “slanted” and “incomplete” information to authorities. Ms. Craighead also alleges that BCBS “slow walked and intentionally evaded their obligation under the contract to timely process the payments” in violation of their contract which resulted in a cash flow problem for K&N. As a result of these actions, Ms. Craighead alleges that the value of K&N was diminished when it was later sold. Ms. Craighead alleges that she was tried on thirty-six (36) counts of TennCare insurance fraud in federal court and was ultimately acquitted. As a result of these alleged actions, Ms. Craighead alleged BCBS is liable for outrageous conduct, malicious prosecution and breach of contract.

The defendant filed a motion for partial summary judgment seeking dismissal of the malicious prosecution claim and the outrageous conduct claim. The trial court dismissed the outrageous conduct claim, and that dismissal is not appealed.3 The rulings which are subject to this appeal are the trial court’s denial of summary judgment on the malicious prosecution claim and its refusal to find that recovery for diminution in value to K&N is barred by the three-year limitations period of Tenn. Code Ann. § 28-3-105.

The trial court gave two reasons for its refusal to dismiss the malicious prosecution claim.

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