Fraud and Abuse
In Tennessee, Medicaid fraud or TennCare fraud, is taken very seriously. Several state agencies work together to track, investigate and prosecute TennCare fraud. This includes The Bureau of TennCare, The Office of the Inspector General, The Tennessee Bureau of Investigation, and the Office of the Attorney General.
Provider fraud can occur when a health care provider charges TennCare for unnecessary or duplicate procedures or visits.
Provider fraud can also occur when a provider charges TennCare for visits or procedures that never took place.
Provider fraud can be reported at the TennCare Fraud Hotline - 1-800-433-3982.
If you are a provider and want more information on TennCare Provider Fraud and Program Integrity, please visit Program Integrity.
Member fraud can occur when someone lies about themselves or their family to obtain TennCare coverage. This can mean lying about their household income, family make-up, or their family's resources.
Member fraud can also occur when someone who has TennCare uses it inappropriately. This can be letting someone else use their TennCare card, doctor shopping by going to several doctors to get the same prescriptions, or selling a prescription to another person.
Member fraud can be reported at the TennCare Fraud Hotline - 1-800-433-3982.