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.” 


Blood Assurance Announces August's Giveaway Winner

Blood Assurance, the regional blood center, announced that the winner of its promotional giveaway for August was Adam Ward of Hixson. Adam won a Windows Surface Tablet.   Blood Assurance is a non-profit blood center that serves 47 counties in a 5 state region, and is the provider of blood and blood components for 70 healthcare facilities. Over 440 blood donors are needed ... (click for more)

Curtis Powell Is Siskin Hospital’s New Vice President Of Quality

Siskin Hospital announced that Curtis Powell has joined the staff as the new vice president of quality. “I am very excited to join Siskin Hospital. I learned of Siskin Hospital while attending a conference in New Orleans last year and am looking forward to building on the great reputation the hospital has established. I am hoping to contribute, using my skills and experience, ... (click for more)

Teen, 17, Charged With Aggravated Rape In Attack On 69-Year-Old North Chattanooga Runner

A 17-year-old has been charged with aggravated rape in connection with an attack on a 69-year-old runner in North Chattanooga on Monday morning. The teen was identified by Juvenile Court officials as Diontae Smartt. Authorities said he has given a confession. Smartt has a detention hearing Thursday at 12:30. The incident happened at approximately 7:30 a.m. ... (click for more)

Berke Implements New Pay Plan For Chattanooga Fire Department

Mayor Andy Berke joined the International Association of Fire Fighters (IAFF) and leadership of the Chattanooga Fire Department to unveil the department’s new pay plan Wednesday afternoon. At a press conference at Fire Hall #1 on Main Street, Mayor Berke and IAFF Local 820 President Jack Thompson signed a memorandum of understanding which sets forth regular raises for fire ... (click for more)

Leaders Lead On Amendment 1

This week the Hamilton County Commission was faced with what I believe may be one of the most important votes they have cast during their tenure.  Granted, the vote was over a "mere" Resolution that resulted in no overt action or new law in our county.  But there are times when simply speaking Truth and taking a stand on a foundational Principle is paramount and as such ... (click for more)

Roy Exum: Expert Reasons Why To Vote

Early voting for the November election begins two weeks from today so please jump-start your plans that will assure your choices will be counted. In a fun-filled attempt to show what some of those who actually vote do during the rest of the day, I offer two examples of “those who live among us” from experts. The first are a series of questions from readers of “Dear Abby” who ask ... (click for more)