Medicaid Fraud Control Division
Every year, MFCD Agents work tirelessly to assist in the prosecution of criminal cases and pursue the recovery of millions of dollars lost to the Medicaid/TennCare program. Additionally, in the area of patient abuse, neglect, and financial exploitation, the MFCD makes referrals of individuals to the Tennessee Department of Health for consideration of placement on the state's Abuse Registry.
Click here for the most recent facts, figures, and data, as submitted to the federal government, about the work of the MFCD.
Click here to read recent news releases about cases investigated by special agents assigned to the MFCD.
Have information about a possible criminal violation we might be interested in investigating?
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The authority of the MFCD, as established by the Code of Federal Regulation and State Statute, is to investigate and prosecute Medicaid provider fraud cases as well as patient abuse and neglect and financial exploitation cases that occur in nursing homes and "board and care" facilities. The MFCD, along with its counterparts in 50 other states the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, investigates and assists in the prosecution of some of the largest and most complex Medicaid provider fraud cases. In addition, the MFCD also aids in the recovery of Medicaid (TennCare) program dollars taken by fraudulent means. The MFCD recognized nationally as the Tennessee Medicaid Fraud Control Unit is a member of the National Association of Medicaid Fraud Control Units (NAMFCU). Being a member of NAMFCU is vital to the current and future success of the MFCD as well as the other member states and territories due to the nationally ever-expanding areas of provider fraud against the government.
The MFCD primarily refers fraud cases for federal prosecution to the United States Attorneys' offices in Tennessee's three federal districts, while abuse cases are prosecuted under state law by the District Attorney Generals in that region. The MFCD, which is required to be re-certified annually by the United States Department of Health and Human Services Office of Inspector General (HHS OIG), receives reimbursement of 75% of its costs from the federal government.
Fraud investigations typically focus on healthcare providers who obtain improper payments for services rendered (or not rendered) to TennCare recipients. Examples of some of the cases worked by the MFCD include billing for services not provided, billing for more than 24 hours in a day, kickbacks, falsifying credentials, and billing twice for the same service.
Patient abuse, neglect, and financial exploitation cases are an important part of the MFCD's workload that continues to grow with increases in the state's aging and vulnerable populations.
Through its membership in the National Association of Medicaid Fraud Control Units (NAMFCU), the MFCD has participated in many effective cooperative efforts with federal authorities to protect federally-funded healthcare programs from health care providers or vendors whose fraudulent activities cause harm to these programs across state lines. These multi-state cases (commonly referred to as “global cases”) are generally limited to Medicaid, Medicare and other federally funded healthcare programs and do not extend to programs funded solely by state government. The MFCD also works very closely with the Medicaid Fraud and Integrity Unit in the Health Care Division of the Tennessee Attorney General’s Office on these cases, as well as other qui tam cases filed in Tennessee.
Do You Have Information About A Possible Medicaid Fraud Case?
Pursuant to 42 CFR 1007 and TCA 71-5-2508, we investigate and refer for prosecution any healthcare providers (such as doctors, ambulance companies, hospitals, home health agencies, and pharmacies) that defraud TennCare. We also investigate and refer for prosecution those who abuse, neglect or financially exploit adults in nursing homes and other healthcare facilities.
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, please contact the Tennessee Office of Inspector General (OIG).