The Medicaid Fraud and Integrity Division is responsible for all qui tam or whistleblower lawsuits where the State has been harmed. These cases include healthcare fraud and other types of false claims lawsuits where the State is alleged to have paid a fraudulent claim for money.
A Provider Fraud Task Force was created to more effectively combat healthcare fraud in the State of Tennessee. Four different offices fighting health care fraud form the Task Force: the Tennessee Attorney General’s Office, the Medicaid Fraud Control Unit of the Tennessee Bureau of Investigation, TennCare, and the Office of Inspector General.
Since 2007, the Task Force has returned $169 million to the State from a variety of companies and healthcare providers who allegedly committed fraud against the State.
In 2008, the efforts of the Task Force were strengthened by passage of a law which made lying or willfully withholding evidence in connection with an investigation of TennCare fraud a felony in Tennessee. The law is similar to one used by the federal government.
In order to have more efficiency in pursuing smaller claims (those less than $25,000), the legislature passed a law allowing such claims to go through the administrative proceedings rather than court hearings.
Anyone who is aware of fraud within the TennCare program is urged to call the TBI Hotline at 1-800-433-5454 to report it. Tipsters may remain anonymous.