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.” 


Nominations Open For Youth Leadership Forum On Medicine

Nominations and applications are now being accepted for the Chattanooga and Hamilton County Medical Society and Medical Foundation of Chattanooga’s 12th annual Youth Leadership Forum on Medicine. The program will be held June 5-8 and includes daily round table discussions with physicians and shadowing a different physician each day. This year, the program is open to rising ... (click for more)

Morning Pointe Launches Alzheimer's Center Of Excellence In Clinton

Local dignitaries, public officials, and community members, as well as residents and their families, celebrated a ribbon-cutting ceremony to mark the conversion of Morning Pointe of Clinton to an Alzheimer’s Center of Excellence. The campus will offer memory and related dementia care services, while Morning Pointe of Powell will continue to offer both assisted living and memory ... (click for more)

2 Shot On Rawlings Street Friday Night; 1 In Critical Condition

Two people were shot, Friday night, and one is in critical condition. At approximately  9:56 p.m.  Chattanooga Police officers responded to the 2000 block of Rawlings Street on a report of a person shot. Officers arrived on scene and located one victim lying next to a vehicle suffering from a gunshot wound. A second victim arrived at a local hospital suffering from ... (click for more)

Car Crashes Into Motel 6 In Dalton; Driver, 17, Admits To Texting While Driving

The Dalton Police Department and Dalton Fire Department responded Saturday morning to a crash at the Motel 6 at Highway 41 and Tibbs Road. The driver of the 2005 Pontiac Grand Prix involved left the roadway and crashed into the Motel 6 building causing severe damage to one of the rooms. There were no major injuries. Investigators believe texting while driving was a contributing ... (click for more)

Slaxxon Regret - And Response

Back in the seventies my three oldest brothers had a buddy named Steve Slack. “Slack” was a star soccer player at Baylor and he grew up on Lookout Mountain, which is where I grew up. He and Jimmy, Henry and Bill went to the University of Virginia where they were roommates in an old, beat up house that was painted pink. Naturally, the place became known as the “Pink Palace” but lest ... (click for more)

Roy Exum: ‘Ballooniac’ Fined $25K

The Calgary Stampede is one of the biggest events in Canada and every year it draws well over 1.5 million people to one of the most beautiful places in the world. It started in 1912 as a big rodeo event and today it lasts 10 straight days. A highlight is the chuck-wagon races, where $4 million of advertisements are sold on the wagon’s canvas covers and there are pancake breakfasts ... (click for more)