Medicaid Fraud

In Tennessee, TennCare provides vital Medicaid services to over 1.6 million Tennesseans. While the MFCD is separate and distinct from the State Medicaid agency, TBI's dedicated agents in its Medicaid Fraud Control Division help deter health care provider fraud, recover program dollars, punish corrupt practitioners, and prosecute those who abuse or neglect residents of nursing homes, certain types of other facilities or Medicaid enrollees.

The TBI investigates two types of Medicaid Fraud cases: provider fraud and patient abuse. Healthcare providers are individuals or businesses such as doctors, ambulance companies, hospitals, home health agencies and pharmacies that bill the TennCare program for services provided to TennCare recipients.

Provider Fraud:

Healthcare providers are individuals or businesses such as doctors, ambulance companies, hospitals, home health agencies and pharmacies that bill the TennCare program for services provided to TennCare recipients.
 

Examples of Medicaid Fraud can include:

• Billing for medical services not actually performed
• Billing for a more expensive service than was actually rendered
• Prescribing medications to Medicaid patients without medical necessity
• Dispensing generic drugs and billing the Managed Care Organization for expensive brand-name drugs
• Kickbacks: Giving or accepting something in return for medical services
• Abuse or neglect of patients in facilities receiving funds from TennCare
• Corporate Medicaid fraud occurring in multiple states simultaneously
• Misuse of Medicaid funds within TennCare or its contractors

If you need to report TennCare provider fraud or patient abuse, please contact the TBI Medicaid Fraud Control Division (MFCD):

Click here to submit a tip via our online submission form

Toll-Free Hotline: 1-800-433-5454

E-mail: TBI.MedicaidFraudTips@tbi.tn.gov

Mail: Tennessee Bureau of Investigation, Medicaid Control Fraud Division, 901 R. S. Gass Blvd., Nashville, TN 37216

If you need to report TennCare recipient fraud (fraud committed by patients receiving TennCare benefits), please contact the Tennessee Office of Inspector General (OIG).

Website: www.tn.gov/oig

Toll-Free Hotline: 1-800-433-3982

E-mail: TennCare.Fraud@tn.gov

Mail: P.O. Box 282368, Nashville, TN 37228