Thursday, December 06, 2018

TennCare fraud is alleged
Officials at a Williamson County-based health care clinic that filed for bankruptcy in August, over-billed TennCare for patient visits and then lied to state officials about it, according to documents in bankruptcy court. Prohealth Rural Health Services operates clinics in Franklin and Columbia, is designated a "rural health clinic" allowing it to earn higher payments in exchange for seeing patients in under-served communities. But Prohealth abused that status to take in millions in unearned payments from the state's Medicaid program for more than five years, according to the allegations by lawyers for TennCare. The scheme allegedly involved using a software system to consistently overstate the number of patient visits. Despite internal warnings, the clinics' operators sent the inflated patient data to the Comptroller's office. An attorney for Dr. White called the allegations "ridiculous." Rural health clinics in Tennessee operate under the oversight of the Comptroller, using a payment plan which allows them to charge higher rates than other health care providers seeing TennCare patients.


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