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.” 


Chattanooga Room In The Inn Gets A New Kitchen And New Look

Chattanooga Room in the Inn, a residential facility for homeless women and children, is chosen as a beneficiary in Karndean Designflooring’s 40 Good Floors for 40 Good Causes Campaign.  Rhonda Gay with Chattanooga Flooring Center nominated the non-profit agency.  At the same time, the Women’s Group of Christ United Methodist Church, under the direction of interior designer, ... (click for more)

12th Annual Minority Health Fair Is Aug. 16

In August 2002, Kappa Alpha Psi Fraternity, Inc. and Omega Psi Phi Fraternity, Inc. partnered with the 28th Community Development Corporation to focus on men’s health issues by providing a free health fair – Hamilton County Minority Health Fair. The primary focus was geared toward prostate exams, blood pressure and other educational services for men. In 2004, Delta Sigma Theta Sorority, ... (click for more)

Plan Proposed For Lookout Mountain, Ga., Homeowners To Pay $10 Per Month For 8 Years For Sewer Upgrades

Lookout Mountain, Ga., officials are proposing a $10 per month charge for each homeowner for eight years to pay for sewer upgrades. The town's sewer system, that was installed 15 years ago, works with the help of grinder pumps at each of the 605 houses in the town. The life expectancy of this equipment is 20 years and the need for replacements has already begun. City Manager ... (click for more)

PAST Act On Horse Abuse Stalls Out In U.S. House Despite 70% Support

Rep. Ed Whitfield (KY-01), chairman of the House Subcommittee on Energy and Power, issued the following statement today regarding the Prevent All Soring Tactics (PAST) Act, H.R. 1518:   “I regret to inform you that Speaker of the House, John Boehner, currently refuses  to bring the Prevent All Soring Tactics (PAST) Act to the floor for a vote.  His decision ... (click for more)

Curtis Adams: Beck, Mackey Should Be Considered For County Commission Leadership

Just think about this;  a person highly qualified applying for a job.  As he is just about finished filling out his papers for his interview, he sees at the bottom there is a place for him to check Democrat or Republican.  He would think, “if I mark the wrong one I may not get the job.” Being a real leader requires honesty, integrity, and, most importantly, fairness. ... (click for more)

Roy Exum: Orchids And Onions

With record low temperatures being recorded around the South, I didn’t know what I’d find in my garden on the first day of August but – sure enough -- there is a profusion of orchids and onions. The start of college football will be later this month and, with the chilly mornings, fall practice is a far cry from what it will be when the sweltering heat comes back next week. Here’s ... (click for more)