NASHVILLE, Tenn. (Legal Newsline) - Tennessee Attorney General Bob Cooper announced a $540,000 agreement Monday with a Memphis pediatric group that allegedly overcharged Tennessee's managed Medicare program, TennCare.
Segal, Parker, Kronenberg, Tsiu & Eiseman LLC and three of its affiliated pediatricians allegedly billed for doctor's visits using codes indicating a higher level of service than was actually provided, a process known as upcoding. Upcoding typically leads to physicians being paid at higher rates than they should be.
TennCare's Office of Program Integrity alleged the overcharging practices after conducting normal data analysis. OPI uses complex algorithms to examine massive amounts of TennCare billing data to identify potential billing outliers. Cooper's office subsequently looked into the pediatric group's practices.
"Reckless acts of overbilling can cost TennCare as much as intentional attempts to defraud the program," Cooper said. "We will continue to follow through on any suspicious billings referred to the office by the TennCare program."
The Tennessee Medicaid False Claims Act allows the state to recover penalties and treble damages against healthcare providers who bill TennCare with reckless disregard to the truth of billings. The state does not allege the group engaged in an intentional scheme to defraud TennCare.
There was no evidence of patient harm found during Cooper's inquiry.