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 frauds, recover program dollars, punish corrupt practitioners, and prosecute those who abuse or neglect residents of nursing homes, certain types of 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
  • Billing twice for the same medical service
  • 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
  • Bribery¬†

To report TennCare provider fraud or patient abuse in Tennessee, call the TBI's Medicaid Fraud Control Unit Hotline: 1-800-433-5454. You can also contact TBI by sending a message to TBI.MedicaidFraudTips@tn.gov.