|
Office
of Inspector General
WHY
WE EXIST
To help prevent,
identify and investigate fraud and abuse within the healthcare
system, most notably the TennCare system.
The vast majority
of our providers and recipients are honest; unfortunately,
a few dishonest people can do great damage to our programs.
Each dollar lost to theft is one less dollar available for
someone in need of care. If we don't work together to help
stop fraud and abuse, the system might not be available for
those whom the program was created to help. Its value can
be measured and substantiated in dollar amounts that would
save our tax dollars. In the absence of checks and balances,
funds may not be available for eligible recipients in the
future.
1-800-433-3982
FRAUD AND ABUSE HOTLINE
DEFINITION OF FRAUD
An intentional
deception or misrepresentation made by a person with the knowledge
that the deception could result in some unauthorized benefit
to himself or some other person. It includes any act that
constitutes fraud under applicable Federal or State Law.
DEFINITION
OF ABUSE
Provider practices
that are inconsistent with sound fiscal, business, or medical
practices, and result in an unnecessary cost to the Medicaid
program, or in reimbursement of services that are not medically
necessary or that fail to meet professionally recognized standards
for health care. It also includes recipient practices that
result in unnecessary cost to the Medicaid/TennCare Program.
TYPES
OF FRAUD AND ABUSE
Examples
of cases that the Office of Inspector General investigates include
unreported income or insurance, TennCare recipients living
out of state, drug seeking behavior, incarceration,
individuals receiving bills (or EOB statements) for services
never provided, provider billing irregularities, over
or under utilization of health care services, and misrepresentation
of credentials. Provider fraud
involves not only doctors, but nursing homes, home
health, durable medical equipment, pharmacies,
mental health facilities, laboratories, transportation
and dentists, to name a few.
WHAT
IS IN IT FOR YOU?
The
Office of Inspector General along with the Tennessee Bureau of
Investigation, Medicaid Fraud Control Unit, Federal Bureau of
Investigation, Attorney General's Office, Department of Human
Services, and many other departmental offices have recovered millions
of public health dollars. We provide our expertise, consultation
and staff to all departments to help combat fraud, abuse, and
waste within the TennCare Program.
CLICK HERE TO
REPORT
FRAUD NOW!
1-800-433-3982 FRAUD AND ABUSE HOTLINE
|
