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.” 


The Lantern At Morning Pointe To Host Hot Dog Fundraiser For Alzheimer's Association

The Lantern at Morning Pointe Alzheimer’s Center of Excellence, Collegedale is hosting a hot dog fundraiser benefiting the Mid-South Chapter of the Alzheimer’s Association. Make a donation and pick up a hot dog with all the fixings on Thursday, Aug. 4, from 10:30 a.m.-2 p.m., at the Elder's Ace Hardware of Ooltewah, located at 9231 Lee Hwy in Ooltewah. Call (423) 396-4700 for ... (click for more)

Medical Tower At CHI Memorial Hospital Sold For Over $9 Million

CHI Memorial’s Missionary Ridge Medical Tower has been sold to Physicians Realty Trust for $9,020,000. Officials said, "CHI Memorial has signed a 10-year master lease on the property for all space occupied by our CHI Memorial Medical Group physician practices and outpatient services such as CHI Memorial Regional Sleep Center and outpatient lab. "All CHI Memorial entities ... (click for more)

Beck Upset By Criticism Of Late WWTA Director Cleveland Grimes In WWTA Analysis; Boyd Won't Rewrite 57-Page Report

County Commissioner Greg Beck said it was inappropriate for fellow Commissioner Tim Boyd to include articles critical of the late Cleveland Grimes in a 57-page report on the Hamilton County Water and Wastewater Treatment Authority. He said, "Criticizing a dead man - I don't know if that's appropriate. If that's Christianity, let me off the wagon." Saying the report should ... (click for more)

Investor In Scheme Says Dyer Made Contacts At Quarterback Club

One of the investors who was a loser in an investment scheme recently halted by the Securities and Exchange Commission said one of the Chattanooga brokers involved made many of his contacts through the Chattanooga Quarterback Club. Paul Smith, former Hamilton County Democratic Party chairman, said Doug Dyer has been the president for many years of the club that promotes UTC and ... (click for more)

Give Bullet-Proof Vests To Every Black Youth In The City - And Response (2)

I heard a report that the Chattanooga police were being given better bullet-proof vests, and I had an idea. What if Chattanooga became known for something besides electric buses and fast internet service? What if Chattanooga provided a bullet-proof vest to every young black man and black youth in the city limits?   I can hear the scoffing as I write, but think about it. ... (click for more)

Roy Exum: Our Horses Vs. DesJarlais

It is well-known that shortly after the despicable “Big Lick” faction of the Tennessee Walking Horse industry put on a very-pointed fundraiser for the equally repugnant Congressman Scott DesJarlais (R-Jasper) two years ago, the misguided doctor has repeatedly tried to bully and strong-arm the U.S. Department of Agriculture on the behalf of the vermin who sadistically torture the ... (click for more)