Shelbyville Doctor Who Allegedly Overcharged TennCare Blasts State’s ‘Intricate Reporting Requirements’

TennCare reportedly overpaid nearly $300,000 of taxpayer money to a Shelbyville physician, according to a report that Tennessee Comptrollers released Thursday. The reported cited Joseph Howard Rupard for failing to accurately report TennCare visits and payments submitted to the state of Tennessee.

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Tennessee Clinic Overcharged TennCare Nearly $5 Million, New Audit Reveals

A west Tennessee primary care clinic overcharged TennCare — and, by extension, taxpayers — more than $4.7 million, according to an audit that Tennessee Comptrollers published late last week.

Officials who oversaw that company, the Grove Primary Care Clinic, closed all three of their facilities in 2019. They did this one day after state auditors announced they would examine the company’s finances.

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BlueCross BlueShield of Tennessee, a Near $1B Vendor to State Government and a TennCare Health Plan Contractor, Mandating Some Employees Get COVID-19 Vaccines and Not Allowing Religious Accommodation

BlueCross BlueShield of Tennessee (BCBST), which received nearly $1 billion in vendor payments from the State of Tennessee during fiscal year 2021 related to state employee healthcare benefits and is one of the Managed Care Organizations handling the state’s TennCare program is enforcing a COVID-19 vaccine mandate and not allowing religious accommodations for some of its employees.
Information was provided to The Tennessee Star by a long-term employee of BCBST, the Tennessee-based independent licensee of the Blue Cross Blue Shield Association, on the condition of anonymity for fear of losing their job.

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Two Tennessee Women Convicted of TennCare Fraud Ordered by the Office of Inspector General to Repay State

According to the Tennessee Department of Finance & Administration, two convicted Tennessee women have been ordered by the Office of Inspector General (OIG) to repay the State of Tennessee on charges involving TennCare fraud.

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Lieutenant Governor Entertains Possibility of Expanding Medicaid

Lieutenant Governor Randy McNally (R-Oak Ridge) appears to have a change of heart on the possibility of expanding Medicaid in Tennessee. According to reports, the White House’s latest plan to expand subsidized coverage caught McNally’s fancy.

Via the American Rescue Plan, President Joe Biden promised that if states expanded their Medicaid programs they’d receive more federal dollars to cover the program. McNally’s spokespersons have indicated that he is open to this option.

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Tennessee State Senate Majority Leader Jack Johnson Talks Block Grant and Big Agenda Items

Monday morning on the Tennessee Star Report, host Michael Patrick Leahy welcomed Tennessee State Senator Jack Johnson to the newsmakers line to weigh in on the Medicaid block grant and the legalities of Joe Biden’s refugee resettlement executive order.

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Governor Lee’s State of the State Address: a ‘Roaring’ Economy, Growth, and Investments in Local Communities

Despite the past year’s events, Governor Bill Lee had plenty of good news for Tennesseans in his State of the State Address. The General Assembly appeared to agree with the governor’s assessments – at many points throughout the address, their socially-distanced, masked audience rose to applaud Lee.

“Scripture has a lot to say about those crossroads and what to do on the heels of suffering. Where do we find promise in this season?” opened Lee. “The promise is found in perseverance which produces character that leads to hope. Tennesseans will know tonight that tragedy has no hold on who we are or where we are headed. Tragedy won’t define us, it won’t rob us of the opportunity that 2021 holds.”

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Tennessee Democrats Ask Biden Administration to Reverse Medicaid Block Grant Waiver

Tennessee Democrats have made multiple pleas to President Joe Biden’s administration, seeking to rescind federal approval for Tennessee’s Medicaid block grant waiver, which is set to allow the state to receive Medicaid funding in a lump sum.

Under the new funding mechanism known as a block grant, Tennessee would receive federal money for the state Medicaid program, TennCare, all at once instead of periodically.

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Tennessee Legislature Approves Modified Block Grant for State’s Medicaid Program

Tennessee’s General Assembly approved the Medicaid waiver, granting the state to apply federal healthcare funding to an aggregate gap model of spending. The legislature filed the bill when it first convened on Tuesday. Just three days after the bill’s introduction, legislators took their final votes on Thursday and Friday. The six subcommittees who reviewed the waiver all recommended its passage over the course of a few days.

The waiver allows the state to establish a self-imposed, fixed budget to last over a ten-year period, known as TennCareIII. It also allows the state to reserve a portion of the unused funds and apply them to other government programs, with potential for those savings to be matched with additional federal funds for healthcare programs.

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Federal Government Approves Tennessee’s Medicaid Proposal, Swapping a Block Grant for an Aggregate Cap

The federal government approved Tennessee’s proposed Medicaid aggregate cap, granting a lump sum for a self-imposed, fixed budget. The ten-year agreement, referred to as “TennCare III,” is the first of its kind nationwide. It also allows for the state to reserve any unused funds and apply them to other government programs, with up to 55 percent of those savings potentially matched by additional federal funds for state health programs.

The Centers for Medicare and Medicaid Services (CMS) described the measure as an “innovative financing approach.” Unlike what various reports claimed, federal officials explicitly stated that this agreement wasn’t a block grant. This agreement allows the state government to be flexible with its spending cap under certain circumstances – like last year’s pandemic and related unemployment crisis. 

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Tennessee Officials Charge Fayette County and Mississippi Women with TennCare Fraud

Tennessee officials have charged two women in separate cases, one from Fayette County and another from Mississippi, with TennCare fraud.

Authorities charged Shuvonda Barnett, 36, of Rossville, with 48 counts of TennCare fraud and two counts of theft of services over $10,000 but under $60,000, according to a Tennessee Department of Finance and Administration press release.

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Murfreesboro Man and South Carolina Woman Charged with TennCare Fraud

Authorities have charged a Murfreesboro man and a South Carolina woman with TennCare fraud, according to two statements the Tennessee Department of Finance and Administration released last week.

Authorities charged that Murfreesboro man, William Weed, 40 with TennCare fraud, a Class D felony, in connection with allegedly selling prescription drugs obtained using TennCare healthcare insurance benefits.

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House TennCare Subcommittee Holds Summer Study on Controversial Medicaid Block Grant Proposal

The House TennCare Subcommittee took on the controversial topic of the block grant proposal, hearing from key stakeholders in a two-hour summer study conducted last Thursday.

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Tennessee Leads the Way by Being the First State to Propose Receiving Federal Medicaid Funding Through a Block Grant

Tennessee became the first state in the nation Tuesday to propose that $7.9 billion in federal funding for the state’s Medicaid program, known as TennCare, would be provided through a block grant.

The release of the 34-page proposal, TennCare II Demonstration Amendment 42, begins a 30-day public comment period, which will end on October 18, 2019.

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Tennessee Officials Charge Even More People with TennCare Fraud

  The number of people state officials have charged with TennCare fraud continues to grow, meaning state taxpayers still subsidize alleged waste, fraud, and abuse out of the program. This, according to two press releases the Tennessee Office of Inspector General released this week. Authorities charged a Wilson County woman…

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State Sen. Dickerson, Others in Pain Management Business Sued By United States, Tennessee for Allegedly Committing $25M in Medicare, TennCare Fraud

  State Sen. Steven Dickerson (R-TN-20) is among those being sued by the federal government and Tennessee over alleged Medicare and TennCare fraud totaling at least $25 million. The United States and Tennessee on Monday filed a consolidated complaint in intervention alleging violations of the False Claims Act and the…

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Georgia Residents Are Allegedly Robbing Tennessee Taxpayers Through TennCare Fraud

  People from Georgia are robbing the taxpayers of Tennessee by taking TennCare benefits to which, legally, they are not entitled. This, according to The Atlanta Journal Constitution, which said authorities are investigating 16 people in Georgia for receiving benefits from Tennessee’s Medicaid program. Those 16 Georgians likely couldn’t get…

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Yet Another Alabama Resident Charged with TennCare Fraud

  Tennessee officials have charged yet another Alabama resident with TennCare fraud, according to a press release from the Tennessee Department of Finance and Administration’s website. This, even though only Tennessee residents are eligible for the TennCare program. Tennessee officials said they arrested Ladreamer Garrett, 27, of Bridgeport, Ala. and charged…

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Five Alabama Residents Arrested for Allegedly Getting TennCare Benefits

  Tennessee officials announced Monday they indicted five Alabama residents on charges of passing themselves off as Tennessee residents so they could qualify for TennCare. No one who lives out-of-state may legally qualify for these benefits. All five people fraudulently reported to Tennessee officials that they and their minor children…

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Law Enforcement Announces More TennCare Arrests in Knox, Williamson, and Blount Counties

  Tennessee officials have arrested more people on charges of TennCare fraud. According to a press release, authorities with the Office of Inspector General and the Knox County Sheriff’s Office charged a Loudon County woman in Knox County with doctor shopping for prescription drugs and using TennCare as payment for…

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U.S. Rep. Green Introduces Bill to Allow States to Pilot Programs in Which Medicaid Recipients Use Swipe Card to Make Medical Purchases

  U.S. Rep. Dr. Rep. Mark Green (R-TN-07) on Tuesday introduced a bill to give Medicaid recipients more choice and power in their healthcare decisions. The Medicaid Improvement and State Flexibility Act would authorize states to begin pilot programs giving Medicaid recipients a “swipe card” with dollars on it designated…

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Davidson and Gibson County Residents Busted for Allegedly Stealing from TennCare

  State officials have arrested three more people for alleged TennCare fraud, according to new press releases from the Tennessee Department of Finance and Administration. The people arrested are from Davidson and Gibson counties, the press releases said. Authorities charged the Davidson County resident, Robert Lee Nesbitt, Jr. 54, with…

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Davidson County Residents Charged with TennCare Fraud

  Authorities have charged two Davidson County residents in separate TennCare fraud cases involving prescription drugs. The Office of Inspector General, with the assistance of the U.S. Drug Enforcement Agency, this week announced the arrest of Omar Adbirizak Hassan, 21 and Shannon Lynne Cannon, also known as Shannon L. Hammock, 36.  Both are…

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Two Tennessee Women Charged with TennCare Fraud in Separate Cases

Tennessee officials this week charged women with TennCare fraud in two separate cases. Officials charged a Hickman County woman with lying to the state to obtain TennCare healthcare insurance benefits, according to a press release from the Tennessee Department of Finance and Administration. The Office of Inspector General and the Hickman…

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Hardin County Woman Charged with TennCare Fraud

A Hardin County woman is charged with allegedly lying about her residency in order to enroll in TennCare, according to the Tennessee Department of Finance and Administration. The Office of Inspector General (OIG), with the assistance of the Hardin County Sheriff’s Office, this week announced the arrest of Samantha J. Briley,…

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