Tennessee Reaches Agreement With Pediatric Group Allegedly Overcharging For TennCare Services

Monday, December 16, 2013

A Memphis pediatric group will pay the State of Tennessee more than $540,000 over five years to settle allegations that the group was overcharging TennCare billings, Attorney General Bob Cooper announced.

 

The State alleged that Segal, Parker, Kronenberg, Tsiu & Eiseman, L.

L.C. and three of its affiliated pediatricians engaged in what is known as “upcoding,” meaning it billed for doctor’s visits using codes denoting a higher level of service than was actually provided.  Such upcoding results in physicians being paid at higher rates than those to which they are entitled.

 

The practice group was identified by TennCare’s Office of Program Integrity (OPI) through the use of data analytics.  OPI discovered the over-billings during its normal data analysis. OPI employs complex algorithms designed to sift through massive amounts of TennCare billing data and identify potential billing outliers. A subsequent investigation by the Attorney General’s Office substantiated the claim that significant upcoding was occurring.  There was no evidence of any patient harm in this case.

 

“TennCare continues its efforts to fight fraud and abuse in the program by using the latest data analytic tools to discover improper behavior,” said TennCare Director Darin Gordon. “This allows us to focus our personnel and resources on those cases that are most likely to involve significant fraud or abuse by Providers.”

 

The State does not allege that the practice group engaged in an intentional scheme to defraud TennCare.  Rather, TennCare provider fraud is pursued under the Tennessee Medicaid False Claims Act, which allows the state to recover penalties and treble damages against healthcare providers who bill TennCare with “reckless disregard” as to the truth of their billings.

 

“Reckless acts of overbilling can cost TennCare as much as intentional attempts to defraud the program,” General Cooper stated.  “We will continue to follow through on any suspicious billings referred to the office by the TennCare program.” 


Fees For Birth, Death Certificates To Increase July 1

The Tennessee Department of Health’s Office of Vital Records is increasing fees charged for providing birth and death certificates. Effective July 1, each type of certificate will cost $15 per copy for both first and additional copies. Birth and death certificates may be obtained by visiting a county health department in Tennessee, in person at the TDH Office of Vital Records ... (click for more)

Debra Chew: Seeing Millennials Minus The Stereotypes

“Millennials have their own individuality and don’t have to fit into any mold” – that was my response/tweet on the recent #MillennialTalk. The question went something like this:  How can 20somethings thrive at work when there are negative millennial stereotypes within the culture? First, I had to ask myself: what are the negative stereotypes associated with millennials?  ... (click for more)

Boyd Asks Coppinger, Compton To Apologize For Chief Of Staff's Outburst; Says Handbook Calls For Termination

County Commissioner Tim Boyd has written a letter to fellow commissioners and the county mayor's office asking an apology from County Mayor Jim Coppinger and his chief of staff, Mike Compton, for remarks after last week's commission meeting. Mr. Compton took strong exception to comments by County Commissioner Tim Boyd about discretionary funds. In a clash between the two just ... (click for more)

Settlement Reached In Case That Was County's Largest Verdict Award; Will Avoid Any Appeals Of Canyon Ridge Litigation

A settlement has been reached in the case in which a Hamilton County Circuit Court jury awarded over $32 million to Chattanooga developer Duane Horton in connection with a resort project on Lookout Mountain that never got off the ground. Circuit Court Judge J.B. Bennett said the two sides had informed him that it was agreed during a mediation session he ordered that there would ... (click for more)

On The News Tonight: A Reflection On A Horrifying Crash And Its Aftermath

On the news tonight,  on the news tonight. The unobtrusive tones on the news tonight. It's just make-believe You can't believe everything you see So baby, close your eyes to the lullabies On the news tonight.   "The News" by Jack Johnson On Journalism On Thursday I was in Jackson, Tennessee playing music. I was a minimum of four hours away ... (click for more)

Roy Exum: My Garden This July

As the month of July dawns this morning, a walk through my garden shows some flowers blooming, my marigolds dying, and the grass is greener than I thought it would be. But as I look for what’s good and what’s bad, let’s remember that some firecrackers pop while others fizzle. Here we go… A BANG to career criminal Whitely Bulger, the 85-year-old master criminal who in a recent ... (click for more)