TennCare Fraud Attorney
What is TennCare?
TennCare is the state-run insurance program for the state of Tennessee. TennCare is a similar program to Medicaid but run by the state government.
If you are a doctor in the state of Tennessee and you see patients and accept TennCare insurance you may be liable for fraud if you defraud TennCare.
What are common criminal charges under TennCare?
Doctors who accept Tenn have a unique position in the medical field because they are the ones who deal with assisting medical professionals with billing insurance companies. Because of their role they are potentially liable for the actions of the doctors insofar as the doctor is trying to fraudulently bill insurance companies.
When you commit an act of fraud against TennCare or the federal government, you may face Tennessee state charges and federal charges for fraud.
What could make me liable for fraud?
If you are a health care provider, you have to be careful of your actions in billing insurance companies and government insurances because you may face criminal liability if you are filing false reports.
For example, if you are making reports to Medicare for doctors visits to a patient and the doctor did not see the patient you may have committed health care fraud.
It is also important to note that TennCare is funded through the state and the federal government so if you file claims under TennCare you might face state and federal charges. If you try to defraud the government of money, you may be liable under the fraud laws.
When do you face these charges?
Attempts and conspiracy charges are much more common when there is a completed crime of health care fraud, and the federal government is trying to charge everyone involved. While it might be easy for the federal government to prove the crime, it might be hard to link the crime to everyone involved which is where the conspiracy and attempt charges come in.
If you are under investigation or charged with any attempt or conspiracy charges related to health care fraud you should contact an attorney with experience defending against health care fraud. Our firm will work with you to get to the bottom of these allegations and help defend you.
What is TennCare Fraud?
In the State of Tennessee, they have their laws on fraud regarding their insurance program TennCare. This law makes it illegal to create any scheme to try and take more money than owed for your work performed.
When you submit a false report, you may be found criminally liable when you submit it to TennCare for payment.
What is Health Care Fraud?
Health care fraud involves sending bills to an insurance company fraudulently, in an attempt to make more money than what is owed for the services you provide.
Health Care Fraud 18 U.S. Code § 1347 makes it illegal to attempt to defraud any insurance company, and several schemes fall under this such as; double billing, billing for services not rendered, or receiving kickbacks.
What is a charge under the False Claims Act?
Any payments that go through Medicare and Medicaid through fraudulently can be prosecuted under the false claims act. The False Claims Act provides criminal and civil liability for knowingly making submitting false records or claims to the government.
As an accountant, if you send these entities any false bills, you may be able to be held liable, even if you are acting on behalf of a doctor. The violation of the False Claims Act may be knowingly, or if you are blatantly ignorant, you may be held liable under this law.
This law is extremely broad and covers several forms of false records. This means that you may be charged even if you don’t know your nursing home is committing this type of fraud, but you should have.
What punishments might I face under these laws?
Under this law, they create a category of crimes based on the amount of money that was taken.
- $500 or less, under 1 year in jail and a fine up to $2,500,
- 500 to $1,000, 1-6 years in prison and a fine up to $3,000,
- $1,000 to $10,000, 2-12 years in prison and a fine up to $5,000,
- $10,000 to $60,000, 3-15 years in prison and a fine up to $10,000,
- $60,000 or more gained 8-30 years in prison and a fine up to $25,000.
The offense of Health Care Fraud comes with a sentence that includes jail time up to 10 years and criminal fines up to $250,000. If any of your patients are injured your sentence can increase to 20 years, and if someone dies you may face life in prison. If you are not proving the proper care for your patients and you are billing for that care, you may encounter a long sentence.
The civil penalty under the False Claims Act is $11,000 for each false claim plus up to three times the damages to the government for the claim. The criminal liability under this law can be assessed only if someone knowingly makes a false claim, and criminal punishment is a fine up to $250,000 and up to 5 years imprisonment.
How can I fight these charges?
Fraud claims in Tennessee come with quite severe sentences. In addition, you might face criminal charges through the federal government. Our firm will help you get to the bottom of your case and determine what defenses are available to you.
For defenses, it is important for us to know the facts of your case to determine how to defend your case best.
What are some cases under TennCare?
Article 1- 40 Counts of TennCare Fraud in illegal prescription case
Vijaya Patibandla a doctor who was practicing in Tennessee was arrested in 2015 in New York for 40 counts of fraud against the state of Tennessee. He was extradited to Tennessee after his arrest and was going to appear before the 8th circuit judges.
Patibandla was practicing in the state of Tennessee and was regularly accepting patients who used TennCare. When he was working in Tennessee, he would routinely write prescriptions for controlled substances illegally. According to the investigation between 2007 and 2010, he was running an illegal prescription scheme.
In 2012 he surrendered his medical license for the state of Tennessee but continued to work in New York up until his arrest in 2015. He faced up to 40 counts of TennCare fraud which could land him in jail for a very long time.
Article 2- Doctor ordered to pay $42,483.93 in TennCare Fraud case
If you submit fraudulent claims, you may end up owing money back in restitution charges. A doctor in Tennessee had to pay back $42,483.93 in restitution when they fraudulently filed insurance claims.
The government sent an undercover agent to Doctor McKenzie’s practice and obtained a narcotic prescription without a doctors visit. Afterward, an investigation began, and they found that she was billing TennCare for services not rendered.
After her grand jury hearing, she entered into a plea deal with the government to pay back the falsely billed services to TennCare and Blue Cross of Tennessee. She ended up owning $42,483.93, with about $24,417 going to TennCare and $18,066.93 going to Blue Cross. She also agreed to one-year unsupervised release where she agrees not to commit any other crimes during the period.
Article 3- Charges against the clinic that gave unlicensed care given to patients
One registered nurse operates medical clinics for low-income individuals was charged with TennCare fraud due to bills she submitted without credentials. He was using doctors credentials to give treatments and prescriptions that she was not licensed to give.
In his plea agreement, she admitted to 1,200 unlicensed treatments without a license. He billed TennCare in total close to $94,000 for treatments that he did not have a license to perform. He used a doctor to help form the clinic but never had a doctor to perform the types of services that he was billing for.
The nurse entered into a plea agreement before a grand jury hearing admitting to the guilt. He is currently awaiting sentencing for his acts for fraud.
What should you do?
As a practitioner in Tennessee, it is important to understand the law in the state regarding fraud. When you are a suspect of health care fraud, you should contact our experienced attorneys to help you through this process. The investigations, questioning, and trials are all important parts of this case, so you need an attorney to represent you through each step.
Our experienced attorney will help guide you through the process and help defend against any of these allegations. Contact our firm today to help you against TennCare fraud charges.