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Medicaid Fraud Control Division

TBI's Medicaid Fraud Control Division investigates and prosecutes Medicaid provider fraud cases, as well as patient abuse, neglect, and financial exploitation cases that occur in nursing homes and "board and care" facilities.

Cox_Michael

Assistant Director
Mike Cox

(615) 744-4000

Every year, MFCD Agents remain aggressive in assisting TennCare recover millions of dollars in restitution for Tennesseans. Additionally, information obtained through patient abuse cases is used to compile the state’s Abuse Registry, which is managed by the Tennessee Department of Health.

Fraud investigations typically focus on healthcare providers who obtain improper payments for services rendered (or not rendered) to TennCare recipients. Schemes commonly 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 MFCD jurisdiction that continues to grow with increases in the state's aging and vulnerable population.

The MFCD is the lead state agency for the National Association of Medicaid Fraud Control Units (NAMFCU) "global cases," which have historically been the most financially productive segment of the MFCD cases involving violations of state and/or federal law. The MFCD also works very closely with the Medicaid Fraud and Integrity Division of the Tennessee Attorney General’s Office on these cases. Medicaid fraud global settlements (and investigations) typically arise in connection with a U.S. Department of Justice (DOJ) investigation against a Medicare provider.

Report An Allegation

Do you have information about provider misuse of Medicaid funds or concerns about a patient receiving Medicaid-funded care? Let us know!