Taylor Law Group Blog

What is TennCare Fraud?

Posted by John C. Taylor | Dec 11, 2015 | 0 Comments

TennCare Fraud Laws Combat Public Health Care Abuse By Both Patients And Doctors

Tennessee Inspector General Manny Tyndall has announced the addition of two more counts of TennCare fraud, arising from a doctor-shopping scheme involving the prescription painkillers Hydrocodone and Oxycodone.

The recent arrest was not made by a traditional law enforcement narcotics squad, and the party charged is not currently facing charges for possession, trafficking, or similar drug-related charges. This illustrates a new twist in Tennessee's war on drugs. Instead, the recent charges arise from the fraudulent use of the TennCare program to pay for doctor's office visits—and the state of Tennessee takes this type of fraud seriously enough that jail time is imminent.

In a press release, Inspector General Tyndall is quoted as saying, “We're committed to eliminating the incidence of people fraudulently obtaining drugs and letting TennCare pick up the tab.”

TennCare fraud, however, can involve more than doctor shopping. Charges are also investigated and pursued against people who misrepresent themselves to gain benefits, such as lying about their income level and employment status in order to become eligible for increased benefits.

The Tennessee Office of Inspector General (OIG), a state agency exclusively devoted to investigations into TennCare fraud, also pursues doctors and health care providers suspected of fraudulently billing TennCare for procedures and office visits that were unnecessary, duplicative, or never occurred. Other state agencies that investigate TennCare fraud include the Bureau TennCare, the Tennessee Office of the Attorney General, and the Tennessee Bureau of Investigation. In addition, the OIG offers rewards for valid tips about TennCare fraud.

Because health insurance policies are complex, Tennessee residents can find themselves in serious trouble, even if they are ignorant about their available coverage, or have relied upon bad information provided by an employer or insurance representative. For example, if you have recently become employed by a company providing private insurance coverage, but are not immediately eligible to receive coverage, it may still be considered TennCare fraud to receive benefits. Some Tennessee residents have been forced to make restitution to the state for costs paid by TennCare in order to avoid a jail sentence. Tennessee residents should also be aware that even lying or willfully withholding evidence in a TennCare fraud investigation is a felony in Tennessee.

Because of this, it is critical for Tennessee residents accused of TennCare fraud to immediately seek the advice of an experienced Murfreesboro criminal attorney skilled in TennCare fraud defense. At the law offices of Dotson & Taylor, Attorneys at Law, our skilled team of Murfreesboro criminal lawyers have more than 40 years of combined experience vigorously defending clients facing felony fraud charges, including TennCare fraud. Our attorneys have the skill and knowledge to parse complex medical and insurance evidence, creating strong, effective defense strategies.

If you are facing TennCare fraud charges, or you believe that state investigators are seeking to question your eligibility for TennCare coverage or any past claims, we urge you to contact us today at 615-890-1982 or online to schedule a free, confidential consultation.

About the Author

John C. Taylor

John C. Taylor is a Murfreesboro native and a graduate of Oakland High School. He earned his bachelor's degree from Furman University in Greenville, SC, where he participated in the Furman Advantage Research program, studying religion in American politics. John also earned his Master's degree.


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