Most doctors, health care providers, suppliers, and private companies who work with public and private health care programs are honest. However, there are a few who aren’t. The United States Attorney’s Office for the Eastern District of Tennessee aggressively fights fraud and abuse by working closely with health care providers and government health care agencies. Fraud costs the TennCare and Medicare programs millions of dollars every year. You pay for fraud with higher health care costs. Fraud schemes may be carried out by individuals, companies, or groups of individuals.
Health care fraud affects every American. Not only is waste, fraud and abuse taking critical resources out of our health care system, it contributes to the rising cost of health care for all Americans and harms the short-term and long-term solvency of these essential programs.
The United States Attorney’s Office for the Eastern District of Tennessee partners with law enforcement agencies and private insurance and health providers to combat health care fraud through the Health Care Fraud Working Group. The Working Group includes members of the FBI, the Office of the Inspector General for the U.S. Department of Health and Human Services, the TBI’s Medicaid Fraud Control Unit, the Tennessee Department of Health, private health insurers and health care providers. The Working Group provides training and information to its members, shares intelligence and information which can be use to investigate and prosecute health care fraud.
Some examples of health care fraud prosecutions brought by our office include:
- Erlanger Medical Center in Chattanooga entered into a five-year Corporate Integrity Agreement as a result of allegations that it had violated the Ethics in Patients Referrals Act (the Stark law) and the Anti-Kickback Statute for its role in a patient referral scheme. These laws are designed to protect the integrity of the government-funded health care benefit programs. Erlanger agreed to pay $37 million dollars to the United States and $3 million to the State of Tennessee.
- East Tennessee Heart Consultants (ETHC) in Knoxville entered into a five-year Corporate Integrity Agreement to settle allegations that it had failed to return excess payments it had received during a six-year period. ETHC agreed to pay $1.7 million to the government and $1.21 million patients and their insurers.
If you are aware of TennCare or Medicaid Fraud please contact the Department of Health and Human Services at http://www.stopmedicarefraud.gov or contact the Tennessee Bureau of Investigation’s Medicaid Fraud Control Unit at 1-800-433-5454 or http://www.tbi.state.tn.us/Crime_invest/medicaid_fraud.