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.” 


Latest Census Bureau Population Estimates Indicate Aging Across Tennessee

According to numbers released Thursday by the U.S. Census Bureau, Tennessee's 2015 median age is 38.6 years, slightly older than the U.S. median age, which rose from 37.7 in 2014 to 37.8 in 2015.  The data release includes national, state and county population estimates for 2015 by age, sex, race and Hispanic origin.  A partner to the U.S. Census Bureau, the Tennessee ... (click for more)

Alexander Says Congress Needs To Pass 21st Century Cures Now

Senate health chairman Lamar Alexander on Thursday said the miraculous eyesight recovery of Tennessean Doug Oliver underscores the need for passage of 21st Century Cures to “unleash medical innovation and give more Americans access to life-changing treatments and life-saving cures, like Doug did.”  Senator Alexander made his remarks at a Bipartisan Policy Center event alongside ... (click for more)

Fire Destroys Highway 58 BBQ

A fire destroyed a barbeque restaurant on Highway 58 on Friday afternoon.   Chattanooga firefighters were dispatched to the Highway 58 BBQ around 6 p.m. The business is located at 4921 Highway 58. Though the business was housed in a small building, the flames and smoke could be seen from a long distance away.  Captain Teri Rose with Quint 6 said the ... (click for more)

2nd Independent Candidate May Be On Walker County Ballot

A second Independent candidate may be on the ballot for sole commissioner of Walker County in the election on Nov. 8. Perry D. Lamb, Jr. has been working toward collecting the necessary 1,640 signatures of registered voters on a petition. His campaign said he is close to the goal. Incumbent Bebe Heiskell is running an an Independent. Election officials said since she was ... (click for more)

Save Coolidge Park - And Response (2)

Last Monday morning while at work a good friend messaged me concerning a matter that I had not heard anything about dealing with Coolidge Park and its future. Apparently that night the City Council was to read an ordinance that would allow the mayor to start negotiations with the relocation of the Medal of Honor Museum. This ordinance would enable the city to lease approximately ... (click for more)

Roy Exum: Tipping The Preacher

I got an unusual telephone call the other day from someone I love who asked my help in solving one of life’s delicate mysteries. It is a tough question: “How do you tip a preacher?” In the first place, you never tip a preacher. It’s the preacher who gives out the tips, helping to keep you on the straight-and-narrow in your quest to waltz through the Pearly Gates. But there are ... (click for more)