TennCare Archives - Page 2 of 2 - Tennessee Star

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

July 24, 2019July 23, 2019 Jason M. Reynolds

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 Tennessee Medicaid False Claims Act by Anesthesia Services Associates, PLLC, doing business as Comprehensive Pain Specialists (CPS), according to a statement by U.S. Attorney Don Cochran for the Middle District of Tennessee and Tennessee Attorney General Herbert Slatery III. The governments allege that the scheme defrauded Medicare and TennCare of at least $25 million. The complaint also names as defendants Dr. Peter B. Kroll, of Goodlettsville; Dr. Steven R. Dickerson, of Nashville; and Dr. Gilberto A. Carrero, of Nashville, three of the principal owners of CPS, as well as John Davis, of Franklin, the former CEO, who was convicted by a jury in April of violating the Anti-Kickback Statute; and Russell S. Smith, a chiropractor from Cleveland. The complaint also states claims for violation of the Federal Priority Statute and common law claims, including unjust enrichment and fraud. A federal judge in April granted prosecutors’ requests to intervene in whistleblower complaints…

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Authorities Say Nashville Man Stole from Taxpayers to Treat His ADHD

July 15, 2019July 14, 2019 Chris Butler

The Tennessee Office of Inspector General announced several new TennCare fraud arrests this week, including the arrest of one man who allegedly used TennCare to treat his Attention Deficit Hyperactivity Disorder. That man, Thomas William Biggs Jr., 44, of Nashville, was on the run for more than a year and a half, according to a Tennessee Department of Finance and Administration press release. “Seventeen months ago, in January 2018, a Davidson County Grand Jury indicted Biggs for TennCare fraud, accusing him of using TennCare to doctor shop for drugs,” the press release said. “Charges say he used TennCare benefits to visit multiple healthcare providers within a short time period to obtain prescriptions for Adderall, an often-abused amphetamine used to treat attention deficit hyperactivity disorder (ADHD).” Elsewhere, according to another press release, authorities charged three Shelby County residents in separate TennCare fraud cases: • Alaa Ahmad, 40, of Memphis, charged with two counts of TennCare fraud and one count of theft of property over $10,000. Ahmad is accused of obtaining TennCare benefits by claiming his minor child was living with him when, in fact, the child lives out of the country. Without the dependent, Ahmad was not eligible for TennCare. •…

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Yet Another Alabama Resident Charged with TennCare Fraud

June 24, 2019June 23, 2019 Chris Butler

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 her with TennCare fraud and theft of services. Authorities said Garrett allegedly applied for and received TennCare benefits for herself and her minor child by fraudulently reporting her residency to appear eligible for TennCare. “Authorities say records show that a month before applying for TennCare, she signed a lease for her residence in Bridgeport, Alabama, where she and her child continue to live,” according to the press release. The Office of Inspector General, with the assistance of the Marion County Sheriff’s Office, announced the arrest. District Attorney General J. Michael Taylor is prosecuting. TennCare fraud is a Class D felony punishable by up to four years in prison per charge. “Lying about one’s residence in order to receive TennCare benefits is a crime,” Inspector General Kim Harmon said in the press release. “We work diligently to preserve TennCare benefits for its intentional use. We welcome information of anyone abusing the system.” As…

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Five Alabama Residents Arrested for Allegedly Getting TennCare Benefits

June 18, 2019June 17, 2019 Chris Butler

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 were state residents so they could qualify for TennCare, according to a press release from the Tennessee Office of Inspector General. Authorities charged the five people, all from Bridgeport, Ala., with TennCare fraud and theft of services: • Bradley Parker, 45 • Amber Parrish, 23 • Robin Miller, 31 • Cassandra Henry, 29 • Jacqueline Shrum, 32 District Attorney General J. Michael Taylor is prosecuting, according to an OIG press release. These five arrests bring the total number of people arrested for TennCare fraud to 3,100 since the OIG began investigating and pursuing this type criminal activity, according to a press release. Tennessee Department of Finance and Administration spokeswoman Lola Potter told The Tennessee Star Monday the number of TennCare fraud arrests is on the decline. According to Potter’s information, Tennessee had the following number of TennCare fraud arrests the previous four years: • 249 arrests in 2015. • 286 arrests in…

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

June 10, 2019June 9, 2019 Chris Butler

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 the pills. Authorities arrested April L. Finger, 45, of Loudon (pictured, right). “An investigation led to the identification of five different instances in which Ms. Finger failed to disclose to her medical providers that she had been receiving prescriptions for the painkillers hydrocodone and Tramadol from other providers, using TennCare as payment,” according to a press release. “A review by the Knox County District Attorney’s Office led to criminal charges for three counts of TennCare fraud.” District Attorney General Charme P. Allen is prosecuting, according to the press release. OIG officials along with members of the Blount County Sheriff’s Office this week announced the arrest of Jamie M. Frisell, 51, of Greenback (not pictured). Authorities charged the Blount County woman with TennCare fraud and theft of services more than $60,000. “Authorities say she falsely reported her income and marital status for the purpose of enrolling in the taxpayer-funded insurance program,” according to…

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Tennessee Officials Announce New TennCare Fraud Arrests

May 26, 2019May 25, 2019 Chris Butler

Tennessee officials have announced several TennCare fraud arrests this month. • Authorities arrested a West Memphis, Ark, woman and charged her with TennCare fraud. They said this woman, Deniqueal S. Townsend, 34, falsely reported she was living in Tennessee to obtain healthcare insurance benefits from the program. The Office of Inspector General, with the assistance of the Shelby County Sheriff’s Department, announced the arrest. Townsend was charged in an indictment with TennCare fraud and theft of property over $10,000. District Attorney General Amy P. Weirich is prosecuting, according to a press release. • Authorities have ordered a Jefferson County woman to repay the state more than $55,000 after she was charged with TennCare fraud and theft of services. The OIG announced that Consuelo Morales, 44, was sentenced in Jefferson County, where she was accused of enrolling herself and her children in TennCare by falsely reporting her income and rental houses. Factoring in those items would have made her ineligible for TennCare, according to a press release. Morales must repay the state a total of $55,244.61 for benefits she and her family allegedly received while they were on the program. Morales was arrested in January of this year when she was charged…

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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

May 15, 2019May 14, 2019 Jason M. Reynolds

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 for medical purchases, Green said in a press release. What is not spent from the card is returned to the holder at year’s end in the form of an Earned Income Tax Credit. Coupled with a catastrophic insurance plan, this ensures Medicaid recipients a safety net while at the same time introducing competition into the healthcare market that will improve the quality of care and drive down costs, the congressman said. “The Republican solution to our country’s healthcare crisis is more choice and better care,” Green said. “We need to move forward and utilize the power of markets to fix our broken system and help those in need. I hope Congressional leaders on both sides of the aisle recognize the need for patient choice and join this effort.” Green introduced his bill as House Democrats are promoting legislation to protect parts of the Affordable Care Act and lower prescription drug…

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Davidson and Gibson County Residents Busted for Allegedly Stealing from TennCare

May 1, 2019April 30, 2019 Chris Butler

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 TennCare fraud for allegedly posing as the spouse of a TennCare enrollee in order to pick up her prescription for the painkiller Oxycodone. Authorities said he went to a pharmacy and claimed he was the enrollee’s spouse so he could obtain the painkillers. They charged Nesbitt with one count of TennCare fraud for making a false statement and receiving benefits he was not entitled to receive, according to the press release. Meanwhile, authorities charged two Gibson County residents with using the identity and TennCare benefits of each other’s minor children in nearby Madison County, a press release said. The Office of Inspector General, with the assistance of the Gibson and Madison County Sheriffs’ Offices, arrested Bertha Campos, 30 and Maria Vega, 42 both of Trenton. Authorities charged them with two counts of TennCare fraud and two counts of identity theft. “Authorities say that initially, Ms. Campos’ child broke an arm and then used the TennCare benefits…

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Davidson County Residents Charged with TennCare Fraud

April 28, 2019April 28, 2019 Chris Butler

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 Nashville residents and were part of a fraudulent prescription ring that was allegedly passing fraudulent prescriptions without the knowledge of the local healthcare providers. This, according to a press release the Tennessee Department of Finance and Administration release this week. Hussan is charged with two counts of TennCare fraud, two counts of obtaining a controlled substance by fraud and two counts of identity theft. Authorities say that on two separate occasions, he used TennCare benefits to present fraudulent prescriptions for the painkiller Oxycodone. The prescriptions contained the fraudulent signature of a healthcare provider along with the provider’s DEA number. Ms. Cannon-Hammock is charged with two counts of TennCare fraud, two counts of obtaining a controlled substance by fraud and two counts of identity theft for similar circumstances. Authorities say that on two separate occasions, she used TennCare benefits when presenting fraudulent prescriptions for Oxycodone using the name and DEA number…

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Franklin Facility Accused of Massive TennCare Fraud

April 15, 2019April 14, 2019 Chris Butler

Tennessee officials said in a press release this week that members of a Franklin-based facility committed fraud to get $6 million in TennCare benefits to which it was not entitled. The U.S. District Court for the Middle District of Tennessee this week made public a suit filed by Attorney General Herbert H. Slatery III against ProHealth Rural Health Services, Inc., and its President and Chief Executive Officer Ray White (pictured above). By filing the suit, the state intervened in a case initially filed by a whistle blower, according to a press release from Slatery’s office. “As a designated Federally Qualified Community Health Center (FQHC) Look-Alike, ProHealth provides healthcare to all patients, regardless of their ability to pay. That status entitled ProHealth to receive Prospective Payment Service (PPS) payments, a guaranteed minimum amount of money per Medicaid patient visit,” the press release said. “As detailed in the complaint, the State alleges White knowingly submitted invoices to the State of Tennessee which falsely inflated the number of Medicaid patient visits to ProHealth from 2012-2017. That caused TennCare to pay ProHealth more than $6,000,000 to which it was not entitled.” The press release quoted Slatery as saying members of his office will not permit leniency…

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Two Tennessee Women Charged with TennCare Fraud in Separate Cases

April 15, 2019April 14, 2019 Chris Butler

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 County Sheriff’s Office, announced the arrest of Heather Knill, 40, of Pleasantville. She is accused of claiming that only she and her child lived in their home on a single income, when in fact the child’s father lived in the home and contributed his income to the household – all of which would have made her ineligible for TennCare. As a result, she received TennCare benefits totaling more than $44,000 and she’s charged with theft of services over $10,000, the press release said. “Omitting relevant facts to purposefully receive public benefits amounts to criminal activity and not taken lightly,” Inspector General Kim Harmon said in the press release. “The Legislature determined that any theft of services greater than $500 is a felony … and in this case, a class C felony, carrying up to 15 years in prison.” “ District Attorney General Kim R. Helper is prosecuting. In the second case,…

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Davidson County Woman Must Repay TennCare in Fraud Plea Deal

April 14, 2019April 14, 2019 Chris Butler

A Davidson County woman is ordered to repay the state after she entered a plea agreement on charges involving TennCare fraud. This, according to a press release from the Tennessee Department of Finance and Administration. The Office of Inspector General this week announced that 38-year old Heather Ann Pitts of Nashville pleaded guilty to charges stemming from allegedly claiming a minor child as a dependent in order to qualify for healthcare insurance benefits through TennCare. Without a child as a dependent, she would not have been eligible for the program. She pleaded guilty to TennCare fraud, theft of services over $10,000 and theft of services over $60,000. In exchange for the plea, Pitts is ordered to pay TennCare $18,000.00 in restitution and she received three consecutive sentences of 11 months and 29 days of supervised probation, according to the press release. “Providing false information in order to receive TennCare benefits is a crime,” Inspector General Kim Harmon said in the press release. “The Office of Inspector General works diligently to preserve the integrity of TennCare benefits, so that those truly deserving of and eligible for TennCare have the best resources.” TennCare fraud is now a class D felony punishable by…

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Hardin County Woman Charged with TennCare Fraud

April 6, 2019April 5, 2019 Chris Butler

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, 31, of Savannah. An indictment charged her with TennCare fraud and theft of services over $10,000 for reporting to the state that she lived in Tennessee when she was actually living in Florence, Alabama, in order to receive TennCare, a press release said. Authorities say as a result, she obtained $15,327.06 in medical assistance benefits. Briley was served while lodged in the Hardin County jail on unrelated charges allegedly involving the sale of methamphetamine, state officials said in the press release. “Lying to the state can be trouble at any time – and it’s against the law to get enrolled in TennCare when living in any other state,” Inspector General Kim Harmon said. “We appreciate citizens bringing information to our attention so we can preserve TennCare benefits for Tennesseans.” District Attorney General Matthew F. Stowe is prosecuting. TennCare fraud is a Class D felony punishable by up to four years in prison…

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Tipton County Woman Charged with TennCare Drug Fraud

April 1, 2019March 31, 2019 Chris Butler

.A Tipton County woman is charged with TennCare fraud in connection with the sale of prescription drugs paid for by the state’s health care insurance program, according to a press release from the Tennessee Department of Finance and Administration. The Office of Inspector General (OIG), with the assistance of the Tipton County Sheriff’s Office, this week announced the arrest of Ursula Patrice Adams also known as Ursula Patrice Ponder, 51, of Covington, Tenn. She is accused of obtaining the dangerous opiate Fentanyl, and on two separate occasions, she allegedly sold a portion of the drugs during an undercover investigation. According to the U.S. Drug Enforcement Agency, fentanyl is 80 to 100 times more potent than morphine. Adams is charged with two counts of TennCare fraud, one count of delivery of a Schedule II controlled substance and one count of casual exchange of a Scheduled II controlled substance. The prescriptions were obtained through Medicare Part B which is paid for in part by TennCare, the press release said. “Tennessee has an opioid problem and we are working with local law enforcement to combat it,” Inspector General Kim Harmon said. “These drugs are deadline, as families across our state are aware. Using…

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Social Justice Warriors at The Tennessean Publish Op-Ed Claiming ‘Tennessee Is a Racist State and So Is Its Legislature’

March 28, 2019March 28, 2019 Jason M. Reynolds

A progressive social justice warrior-community organizer has labeled the entire State of Tennessee as racist with the aid of The Tennessean, which ran her ranting op-ed Wednesday. Aftyn Behn describes herself as the statewide organizer of Indivisible for Tennessee and Kentucky. Her op-ed blaming the state – especially the General Assembly – for a host of social ills is available here. She says, Let me be clear: Tennessee is a racist state. Racism is in the air we breathe, permeating the State Capitol, codified in the legislation being passed at the detriment of women, communities of color, and the working poor. Our problem with racism in this state is wild and untamed, and Justin Jones has turned a mirror to the legislature and the gubernatorial administration, inviting them to look inward and prompt introspection towards their ideologically destructive agendas. Lawmakers are responsible for rising black maternity rates, not allowing ex-felons to vote and is “the motivation behind undermining years of tireless organizing efforts from women of color to pass Nashville’s Community Oversight Board,” among other social ills, she said. Not expanding Medicaid is also a part of her complaint. The Tennessee Star has reported on Justin Jones, who allegedly threw…

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Tennessee Gov. Bill Lee Wants More People to Fight Medicaid Fraud

March 15, 2019September 20, 2019 Chris Butler

Tennessee Republican Gov. Bill Lee reportedly wants more people to fight Medicaid fraud. Specifically, according to LocalMemphis.com, Lee wants more Tennessee Bureau of Investigation staff members on the trail of Medicaid fraud. “The TBI director hopes lawmakers approve a request for 26-more staffers in the agency’s Medicaid fraud control unit,” the website reported. “The group looks for wrongdoing in the state’s huge $12-billion Medicaid program TennCare, that takes up about 30 percent of the state budget.” The Tennessee Star has recently reported several TennCare fraud arrests. Tennessee officials, for instance, have announced the arrests of five people charged with TennCare fraud. According to press releases state officials put out this month: • Authorities charged a Sullivan County woman with TennCare fraud in connection with the sale of prescription drugs obtained through the state’s health care insurance program. • Authorities charged a Shelby County woman with TennCare fraud involving doctor shopping, which involves visiting multiple doctors in a short period of time to obtain controlled substances. • A Davidson County woman charged with TennCare fraud, meanwhile, must repay the state for benefits allegedly received through the healthcare insurance program in a plea deal in Shelby County, according to Tennessee officials. • A…

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Tennessee Officials Announce a Slew of New TennCare Arrests

March 3, 2019March 2, 2019 Chris Butler

Tennessee officials have announced the arrests of five people charged with TennCare fraud. According to press releases state officials put out this week: • Authorities charged a Sullivan County woman with TennCare fraud in connection with the sale of prescription drugs obtained through the state’s health care insurance program, according to a press release. The Office of Inspector General with the assistance of the Kingsport Police Department, arrested Pamela A. Mendenhall, 50, of Kingsport. Authorities accused her of using TennCare to obtain the painkiller Oxycodone, then selling a portion of the drugs on three separate occasions. Authorities charged her with three counts of TennCare fraud, sale and delivery of Oxycodone within 1,000 feet of a park, sale and delivery of Oxycodone within 1,000 feet of a school and maintaining a dwelling where controlled substances are used or sold. Mendenhall allegedly obtained the prescriptions through Medicare Part B, which TennCare partly pays for. • Authorities charged a Shelby County woman with TennCare fraud involving doctor shopping, which involves visiting multiple doctors in a short period of time to obtain controlled substances, a press release said. The OIG, with the assistance of the Shelby County Sheriff’s Office, announced the arrest of Cassundra Woodman, 28, of…

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Macon County Woman Charged with Using Children to Commit TennCare Fraud

March 2, 2019March 1, 2019 Chris Butler

Tennessee officials charged a Macon County woman with fraudulently obtaining TennCare benefits, according to the state’s Department of Finance and Administration. That woman, Hanna L. Johnson, 30, of Red Boiling Springs, allegedly and falsely claimed two minor children as dependents. Without those children, Johnson would not qualify for TennCare, Tennessee officials said Tuesday. Johnson pleaded guilty to theft over $10,000. In exchange, she must pay TennCare $6,000. Johnson also received six years of supervised judicial diversion, according to a state press release. “Providing false information in order to receive TennCare benefits is a crime – and that crime is theft from state taxpayers,” Inspector General Kim Harmon said in the press release. “The OIG works diligently to preserve the integrity of TennCare benefits so those truly deserving have the best resources.” District Attorney General Tom P. Thompson, Jr., prosecuted the case. TennCare fraud is a class D felony punishable by up to four years in prison, state officials said in the press release. The OIG, which is separate from TennCare, began full operation in February 2005 and has investigated cases leading to more than $3 million being repaid to TennCare, with a total estimated cost avoidance of more than $163.6 million for TennCare, according to latest figures. To date,…

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State Rep. Timothy Hill: Medicaid Block Grants Are the Conservative Way to Expand TennCare Coverage

February 14, 2019February 13, 2019 Laura Baigert

NASHVILLE, Tennessee – State Representative Timothy Hill is sponsoring HB 1280, which is the first step in the process of requesting Medicaid block grants for the funding of TennCare. The main reason Representative T. Hill is bringing the legislation, he told The Tennessee Star, is that block grants are the conservative way to expand the coverage that TennCare provides. Senator Paul Bailey (R-Sparta) is sponsoring the companion bill SB 1428 in the State Senate, where the measure already has 22 Republican co-sponsors, including Lt. Governor McNally, of the potential 25 Republican State Senators. Representative T. Hill explained that, in doing research, “we found the block grant concept is not new – President Reagan tried it in 1981, Newt Gingrich in the 90’s and was almost successful, and now President Trump has expressed interest for this concept.” “So, Senator Bailey and I feel like it’s the right time to try it again and to try it from the State’s perspective,” continued Hill. Hill doesn’t know how many other states are attempting to take the block grant approach, which is “a fundamental shift in how you pay for the program,” as he put it. Hill said that with Tennessee being a very…

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Weakley County Woman Charged with TennCare Fraud

February 9, 2019February 8, 2019 Chris Butler

Authorities have charged a Weakley County woman with TennCare fraud. Officials with the Tennessee Office of Inspector General say the woman, Tina Mays, 44, of Gleason, fraudulently used the state’s health insurance program to obtain controlled substances, according to a state press release. The practice is otherwise known as doctor shopping. OIG officials, along with Madison County Sheriff’s officers, arrested Mays. They charged her with four counts of fraudulently using TennCare to visit multiple doctors to obtain prescriptions for the painkiller Hydrocodone, according to a press release. “Tennesseans won’t stand for TennCare resources to be used to fuel the opioid crisis,” Inspector General Kim Harmon said in the press release. “The Office of Inspector General works diligently with other state and local agencies to deter prescriptions being diverted to the streets.” TennCare fraud is a Class D felony carrying a sentence of up to four years in prison per charge. District Attorney General Jody Pickens is prosecuting, according to the press release. State officials have made other TennCare fraud arrests of late. As The Tennessee Star reported this month, law enforcement officials have charged a Jefferson County woman with allegedly falsifying her income to obtain healthcare insurance through the state program. A…

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Jefferson County Woman Charged with TennCare Fraud

February 4, 2019February 4, 2019 Chris Butler

Law enforcement officials have charged a Jefferson County woman with TennCare fraud. That woman, Consuelo Morales, 44, allegedly falsified her income to obtain healthcare insurance through the state program, according to a state press release. The Office of Inspector General with the assistance of the Jefferson City Police Department arrested Morales. A Jefferson County grand jury charged her with TennCare fraud theft of property over $10,000, the press release said. “The indictment says Morales knowingly obtained TennCare benefits with the intent to avoid payment for services by failing to properly report to the state her spouse’s income, real estate assets and the fact that her family was eligible for private insurance through her spouse’s employer,” according to the press release. “Providing false information in order to receive TennCare benefits is a crime Tennesseans will not tolerate,” said Inspector General Kim Harmon. District Attorney General James B. Dunn is prosecuting. TennCare fraud is a class D felony punishable by up to four years in prison. Theft of property over $10,000 is a Class C felony punishable by up to six years in prison, according to state officials. As The Tennessee Star reported in December, authorities arrested and charged a Florida woman with TennCare fraud…

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TennCare Recipients Might Soon Reportedly Have to Start Working

January 25, 2019January 24, 2019 Chris Butler

If you are on TennCare then you may have to put on your boots, roll up your sleeves and get to work if you still want your benefits, according to the Memphis-based WMC Action News 5. “The state of Tennessee is asking the Trump administration to enact those requirements. They said it would apply to roughly 56,000 Tenncare recipients,” the station reported. “However, there is concern about some details of the plan. In an application to Medicaid in late December, state officials said Tenncare work requirements would not impact pregnant women, the elderly, disabled, or those with certain medical conditions.” Tenncare’s plan, WMC went on to say, asks that recipients put in 20 hours a week of community service, education, or work for four out of six months. Tennessee has 1.3 million people on Tenncare. The work program would affect only 56,000 of those recipients, the station said, without specifying further. The idea for this comes from the neighboring state of Arkansas, WMC reported. “Arkansas is the first state in the nation to implement a Medicaid work requirement and kicked more than 17 thousand people off Medicaid in 2018 for failing to report their work activities,” according to the station.…

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Woman Charged with TennCare Fraud for Sixth Time

December 17, 2018December 17, 2018 Chris Butler

Authorities in Tennessee this week arrested and charged a Florida woman with TennCare fraud — for the sixth time. That woman, Desiree McIntyre, 29, of Ocala, Fla. faces three counts of TennCare fraud in Sullivan County by doctor shopping, according to the state’s Office of Inspector General. That particular offense involves using TennCare to visit multiple doctors in a short period of time to obtain prescription drugs. Despite saying she was from Florida, state officials said McIntyre lived in Tennessee at the time of the alleged incidents. Her previous arrests occurred outside of Sullivan County. “McIntyre was indicted in Cocke and Davidson Counties in October and November 2017, when she was accused of doctor shopping for Hydrocodone, Oxycodone and Hydromorphone, which is another strong pain medication sometimes sold as the brand drug Dilaudid,” said officials with Tennessee’s Department of Finance and Administration, in a press release. “McIntyre’s first three arrests occurred in May, July and August of 2012, in Cocke, Sevier and Hamblen Counties, resulting from simultaneous investigations. Those charges involved doctor shopping for Hydrocodone and Oxycodone, using TennCare as payment.” McIntyre, state officials went on to say, pled guilty in her first three arrests. Authorities ordered her to serve…

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Audit: TennCare Gave Out Money to Dead People and People in Prison

December 11, 2018December 10, 2018 Chris Butler

TennCare gave out more than $700,000 to duplicate members and also to people who were already dead or incarcerated, according to a new state audit. All of those recipients were ineligible to receive TennCare money. The findings, released late last week, cover July 2016 through December 2017. Generally, TennCare must refund the federal share of Medicaid overpayments to the Centers for Medicare and Medicaid Services, auditors wrote. “TennCare should investigate providers who billed for services that took place after a member’s date of death or during a member’s incarceration to determine if fraud occurred,” auditors wrote. As for people in prison, auditors said “TennCare should work with the Tennessee Department of Correction and its incarceration data contractor to establish a more effective process for identifying and verifying TennCare members who are incarcerated and suspending those members immediately.” TennCare, auditors went on to say, should also retroactively recoup any payments made on behalf of incarcerated TennCare members. TennCare officials should weed out payments made to members with multiple TennCare identification numbers, auditors wrote. In a written response to auditors, TennCare officials said they concur with some of the findings. TennCare officials, though, said they disagreed with Comptrollers’ findings on payments to…

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Letter to the Editor: The Way to Lower Healthcare Costs Is to Support and Elect Candidates Who Will Apply Free Market Principles

October 5, 2018October 3, 2018 Admin

doc nurse senior patient

Dear Tennessee Star, During the U.S. Senate debate I was glad to see Congressman Marsha Blackburn speak out against single payer healthcare. Being in the healthcare industry professionally since 1980 and now as a health consultant focused on health care legislation and helping companies and individuals navigate health care costs, pricing and affordability and keeping legislators informed from the provider perspective of the hindrances to care as a result of government intrusion – I know that single payer health care has disastrous implications. Obamacare has taken us in the wrong direction since 2010 – limiting access to plans, skyrocketing double digit cost increases each year, a diminishing individual marketplace, disappearing insurance plans and greatly reducing provider choice – it has been in direct contradiction to the two promises given to the American Healthcare consumer – If you like your doctor, you can keep your doctor, and it will reduce the costs to consumers. It is unfortunate that many mainstream Democrats are taking a bad idea and setting the stage to make matters much worse. Now many Democrats support Senator Bernie Sanders’ proposal to nationalize our health care system via single payer – also known as “Medicare for All.” In reality,…

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TennCare Releases Abortion Statistics

September 11, 2018 Chris Butler

Over the past five years TennCare has paid for, on average, three abortions per year. TennCare spokeswoman Sarah Tanksley told The Tennessee Star that TennCare only covers abortions in “extremely limited circumstances” required by federal law — rape, incest, or when the mother’s life is endangered. These were among some of the statistics the Tennessee Department of Health released this week at The Star’s request. According to TennCare statistics, in 2017 TennCare covered six abortions, all falling within federal requirements. The state spent $2,026.54. The year before, TennCare covered three abortions, and the state dollar spend for that was $765.55. Meanwhile, in 2015 TennCare covered one abortion with the state spending $519.27. The Star also requested stats on how much money the state gave Planned Parenthood during the past three fiscal years. The organization received $14,787.92 in 2015. That amount more than doubled to $31,855.97 the following year. In 2017 the amount decreased slightly to $27,679. “Please note that these (Planned Parenthood) expenditures were for family planning services,” Tanksley said in an emailed statement regarding the organization. Planned Parenthood offers family planning services as well as abortions. “No Medicaid dollars were used to pay for abortions performed at Planned Parenthood…

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Report: Tennessee to Get Tough with Planned Parenthood

August 31, 2018August 30, 2018 Chris Butler

Planned Parenthood

Tennessee officials may soon have the power to stop Medicaid dollars from going to clinics in Tennessee that perform abortions. This is meant to curb the power and influence of Planned Parenthood in Tennessee, according to a new article in Bloomberg. “The move signals growing GOP interest in using administrative means to rein in providers that offer abortion and underscores state confidence in the Trump administration’s friendliness to the conservative policy priority,” the website reported. Nationwide, the group received $543.7 million in taxpayer money in fiscal year 2016. Medicaid funds generally can’t get used to cover most abortions under the Hyde Amendment, Bloomberg reported. The Tennessee Star has requested state officials give specific information about how much money abortion providers in Tennessee have received through Medicaid during the past three fiscal years. The Star expects to receive that information sometime next week. Tennessee officials are asking the Centers for Medicare & Medicaid Services to block providers that performed more than 50 abortions in the past year from its Section 1115 Medicaid waiver, Bloomberg reported. The publication quoted an unidentified spokeswoman for the state’s Medicaid program TennCare. “Public comments on the request close Sept. 23,” Bloomberg reported. TennCare pays for health care…

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Gov. Phil Bredesen Cut Elderly, Sick and Disabled From TennCare While Enrolling Refugees

August 16, 2018August 15, 2018 Chris Alto

Phil Bredesen

Phil Bredesen, the health insurance executive turned governor, had an antidote to contain the spiraling costs of the state’s Medicaid program – disenroll elderly, sick and disabled Tennesseans from TennCare. According to Gordon Bonnyman, co-founder of the Tennessee Justice Center, two years into Bredesen’s first term as governor, “[a]pproximately 200,000 of [TennCare’s] costliest patients lost their coverage over a four-month period in late 2005.” Bonnyman characterized this group as the “sickest subgroup of the TennCare population.” The TNReport calculated that by the time Bredesen left office in 2011, approximately 350,000 Tennesseans were cut from TennCare which included an estimated 100,000 people with disabilities. At the same time that Tennesseans were losing their TennCare coverage, refugees being resettled in the state were being assisted by refugee resettlement contractors to enroll into TennCare. A spokesman for State Senator Bill Ketron’s office confirmed to The Tennessee Star that Holly Johnson, director of Catholic Charities’ Tennessee (CCTN) Office for Refugees (TOR) provided data requested by the Senator which included the number of arriving refugees being enrolled into TennCare. Senator Ketron’s office shared that data with The Star. Bredesen’s action several years earlier of withdrawing Tennessee from administering the federal refugee program created the opportunity for…

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On the Question of TennCare Expansion, Answers Fall Along Party Lines for Gubernatorial Candidates

January 22, 2018January 22, 2018 Admin

Healthy Tennessee, a Nashville-based 501(c)(3), hosted a healthcare symposium Friday featuring several of the gubernatorial candidates from both parties with moderators Lipscomb President Randy Lowry and Healthy Tennessee Founder President Dr. Manny Sethi. Although the event was slated to have the candidates “share their vision and plans for a healthier Tennessee,” the discussion largely centered around the question of whether and how much should Tennessee’s Medicaid program, TennCare be expanded. “Our forum is designed to provide a meaningful opportunity for each candidate to speak directly to the voters of Tennessee and provide a unique perspective on potential solutions to the health care problems facing our state today,” said Lipscomb University President Randy Lowry in a statement about the gathering. In all, six out of the seven candidates vying for their parties’ nominations were on hand, with each individual taking the stage to share their thoughts with the moderators and audience one at a time. Both Democrat candidates, former Nashville Mayor Karl Dean and state House Minority Leader Craig Fitzhugh, joined Republicans House Speaker Beth Harwell, Franklin-area businessman Bill Lee, Knoxville-area businessman Randy Boyd, and former State Senator Mae Beavers. The only top-tier candidate not attending was Representative Diane Black, who opted to stay in Washington D.C. amid the looming…

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Tennessee Legislators First in Nation to Help Home Health Care Providers Get Paid

February 16, 2017February 16, 2017 Chris Alto

A bill filed by Rep. Judd Matheny (R-Tullahoma) and Sen. Janice Bowling (R-Tullahoma), “The HMO Transparency in Claims Processing Act of 2017,” makes Tennessee the first state to address problems home health care companies encounter in getting paid for their services. HB51/SB133 will establish processes to facilitate prompt payment of claims and improved management in addressing the denial of claims for services delivered by home health care providers. Home-based health services can provide an alternative to the nursing home model by offering care that enables seniors to “age in place,” often in their own residence and communities. According to AARP, seniors who have depleted their assets or never had resources sufficient to pay for needed care, typically resort to Medicaid as their safety net: “Nearly a third of older people are projected to deplete their life savings and turn to Medicaid for assistance as their ability to care for themselves declines.” However, data collated by AARP in 2013 showed nursing home use by seniors enrolled in Medicaid programs had decreased by about one-third since 1995, “despite the enormous growth among the oldest age groups most at risk of using nursing home services.” AARP credits the use of private and less…

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