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.” 


Erlanger Health System Seeks Arts Curator

The Arts at Erlanger committee is searching for an individual who has experience in the art community and is interested in archiving and updating inventory of existing and new artwork within the Erlanger Health System.   The new curator for the “Healing through the Arts” initiative will assist the committee in creating a new atmosphere for patients and their guests at ... (click for more)

CHI Memorial Announces 2015-2016 Board Of Directors

CHI Memorial announces officers and members of the board of directors.  Sister Judith (Judy) Raley, Sisters of Charity of Nazareth, has been named chair of the board of directors. Sr. Raley moved to Chattanooga in 1995 to provide spiritual care for patients, families and staff at CHI Memorial. As CHI Memorial’s senior vice president of Mission from 1996-2007, she led efforts ... (click for more)

Abdulazeez Apparently Went Target Shooting In River Gorge Area Prior To Rampage That Killed 5

A 24-year-old Hixson man who went on a rampage and killed five military personnel at Chattanooga apparently went target shooting in the Tennessee River Gorge area just beforehand. A Chattanoogan said he was canoeing the day before the shooting and heard Mohammad Abdulazeez shooting in the woods in a remote area. The man, who said he thought he was being shot at, looked ... (click for more)

Columnist Says Navy To Bring Charges Against Commander Of Chattanooga Naval Center Who Fired At Shooter

The Navy plans to bring charges against Lt. Cmdr. Timothy White, who fired shots at a Hixson man who on July 16 rammed through a gate at the facility on Amnicola Highway and killed four Marines and a sailor, columnist Allen West wrote. He said he received a text message confirming the charges are imminent against the Chattanoogan, who is the father of six and who has acknowledged ... (click for more)

Chattanooga Is A Blessed Community

I am an American by birth and a Chattanoogan by the Grace of God. (A phrase I borrowed from the late Lewis Grizzard and modified) I grew up in Chattanooga / East Ridge – Anna B. Lacey Elementary, Dalewood Junior High, Brainerd High, degree UTC.  My family lived in Chattanooga until March of this year but I’m still up every month visiting friends.   I have been following ... (click for more)

Roy Exum: We Fight For Lieutenant Commander White

The United States Navy has run a tight ship since it was founded in October of 1776. You’ll recall that was when Capt. John Paul Jones began to forge the steel with the words, “I have not yet begun to fight.” Some years later Adm. David Farragut etched himself into Navy lore when he cried, “Damn the torpedoes! Full speed ahead!” During the attack on Pearl Harbor, Lt. Howell Forgy ... (click for more)