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 Cancer Support Group Leader Reports From American Hematology Conference

Joining a record-breaking 26,000 hematologists and healthcare professionals who attended the recent 56th American Society of Hematology Annual Meeting and Exposition in San Francisco, Ca. were 12 cancer patients and support group leaders.  Linda Huguelet, co-leader of the Chattanooga Multiple Myeloma Networking Group, was one of them. At the conference, Ms. Huguelet was ... (click for more)

Family Honors Landyn Stratham By Delivering Toys To Children's Hospital

With the overwhelming support from residents and businesses in Winchester,Tn., family and friends of Landyn Stratham successfully coordinated a community toy drive and delivered over 1,200 toys to T.C. Thompson Children’s Hospital at Erlanger.  Four-year-old Landyn spent many days in Children’s Hospital as he was battling cancer. His family saw first hand the compassion ... (click for more)

Investor Group Plans $31 Million Hotel In Chattanooga Bank Building

An investor group announced that it is planning the development of an upscale 150-room hotel in the historic Chattanooga Bank Building. MCA is comprised of 20 EB-5 investors as limited partners with Red Leaf Development, managed by David Roos, as the general partner. Long-time partner PHG is involved in the development of the hotel and will be responsible for its management ... (click for more)

Police Say Texts From Slain Minister Detailed Drug Deals

An investigator testified Thursday that a minister who was beaten to death during an apparent drug deal had texts on his phone dealing with similar exchanges of illegal drugs. The minister's wife said he had gone out that night as part of a church counseling program to women. General Sessions Court Judge Clarence Shattuck bound charges of felony murder and especially aggravated ... (click for more)

Please Don't Close The Piccadilly Cafeteria At Hamilton Place

Oh, no. The Piccadilly Cafeteria at Hamilton Place is closing.  Its last day is Christmas Eve.  I will miss the great food they have there but most of all I will miss their servers, cashiers and waitresses.  They are all so friendly and accommodating.  They make it like it’s a home-style restaurant. I sure wish there was some way that Hamilton Place and ... (click for more)

Roy Exum: The Last Day Of School

AUTHOR’S NOTE: This story first appeared in the Chattanooga News-Free Press in the early 1980s and every year since then I have been asked repeatedly about it. It is easily the most famous story I have ever written – copies have been sent to me from numerous foreign countries -- and it may be the easiest story I ever wrote. All I did was write what the noted religious psychologist ... (click for more)