Is Your Tennessee Health Care Employer Submitting False Claims to Medicaid?
Tennessee Medicaid, “TennCare” ensures that quality health care services are available to vulnerable and low-income Tennessee residents. Unfortunately, corrupt and dishonest physicians, hospitals, clinics, pharmacists and other medical professionals attempt to pocket Tennessee Medicaid funds for themselves. These fraudsters continue to steal hard-earned taxpayer dollars by illegally billing Tennessee Medicaid for medically unnecessary services, services never provided, illegal kickbacks and more.
The State of Tennessee considers the fraudulent obtaining and/or use of Tennessee Medicaid funds a felony. The Tennessee Bureau of Investigation and its Medicaid Fraud Control Unit work to ensure that Tennessee taxpayer dollars are spent properly and patients receive safe, quality care. In 2015, The Tennessee Medicaid Fraud Control Unit prosecuted 21 criminal convictions and 18 civil settlements and judgements, recovering nearly $40 million in stolen funds for the State of Tennessee.
Though the Tennessee Medicaid Fraud Control Unit continues to crackdown on fraud, government resources dedicated to discovering Tennessee Medicaid fraud, waste and abuse are limited. It is up to medical professionals like physicians, nurses, pharmacists, EMT’s and sales representatives to report any knowledge of fraud. If you feel you have knowledge of Tennessee Medicaid fraud, you may be entitled to a cash award of over $1 million. Call today for a free, immediate and confidential case evaluation.
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Reporting Tennessee Medicaid Fraud
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What Laws Cover Reporting Tennessee Medicaid Fraud?
The Tennessee Medicaid False Claims Act (TMFCA), T.C.A. §§ 71-5-181 et seq., allows private citizens to file a whistleblower claim on behalf of the State of Tennessee when they suspect fraud against the TennCare program or any successor program to Tennessee Medicaid.
A person violates the TMFCA when they:
- Knowingly present, or cause to be presented, a false or fraudulent claim for payment or approval under the Medicaid program;
- Knowingly make, use, or cause to be made or used, a false record or statement material to a false or fraudulent claim under the Medicaid program;
- Conspire to commit a violation of the TMFCA; or
- Knowingly make, use, or cause to be made or used, a false record or statement material to an obligation to pay or transmit money, or property to the state, or knowingly conceal, or knowingly and improperly, avoid, or decrease an obligation to pay or transmit money or property to the state, relative to the Medicaid program;
"Knowing" and "knowingly" mean that a person:
- Has actual knowledge of the information;
- Acts in deliberate ignorance of the truth or falsity of the information; or
- Acts in reckless disregard of the truth or falsity of the information.
No proof of specific intent to defraud is required to establish a violation of the TMFCA.
Violations of the TMFCA are punishable by a civil penalty of between $5,000 and $25,000 per false claim, plus three times the amount of damages the state sustains because of the act of that person.
Medicaid fraud wastes valuable taxpayer dollars and increases the cost of health care for everyone. Tennessee State and Federal False Claims Acts provide whistleblowers with large cash awards for blowing the whistle on Tennessee Medicaid Fraud. Whistleblowers can also seek remedies for employer retaliation experienced after reporting fraud. If you have knowledge of Tennessee Medicaid fraud, you may be entitled to a cash award of over $1 million. Call today for a free, immediate and confidential case evaluation.
Does Tennessee Law Protect Whistleblowers From Employer Retaliation After Reporting Medicaid Fraud?
Under the Tennessee Medicaid False Claims Act (TMFCA), T.C.A. §§ 71-5-181 et seq., any employee, contractor, or agent shall be entitled to all relief necessary to make that employee, contractor, or agent whole, if that employee, contractor, or agent is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment because of lawful acts done by the employee, contractor, agent, or associated others in furtherance of an action or other efforts to stop one or more violations of the TMFCA.
The relief shall include:
- reinstatement with the same seniority status the employee, contractor, or agent would have had but for the discrimination
- two times the amount of back pay
- interest on the back pay, and
- compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys' fees.
Under Tennessee’s State Employee Whistleblower Law, Tenn. Code. Ann. § 8-50-116, no head of any state department, agency or institution, state employee exercising supervisory authority, other state employee or state contractor shall discharge, demote, suspend, reassign, transfer, discipline, threaten or otherwise discriminate against a state employee because reports or attempts to report, verbally or in writing:
- The willful efforts of such person or agency or contractor to violate a state or federal law, rule or regulation which had or would have had a material and adverse effect upon program operations or program integrity, or the willful efforts to conceal such a violation;
- Acts which constituted fraud against the state, the federal government, the public or any fellow employee;
- The willful misappropriation of state or federal resources; or
- Acts constituting gross mismanagement of a program, gross waste of state or federal funds, or gross abuse of authority.
The court may order injunctive relief, actual damages, reinstatement of the employee, the payment of back wages, full reinstatement of fringe benefits and seniority rights, costs, reasonable attorney's fees or any combination thereof.
If your health care employer has demoted, fired, harassed, threatened or otherwise discriminated against you for reporting Tennessee Medicaid fraud, you may be eligible to file a claim for damages. Timing is critical. Don’t hesitate to file a claim. Call the Medicaid Fraud Hotline now for a free, no-obligation case evaluation.
What Cash Awards Are Paid for Reporting Tennessee Medicaid Fraud?
Under the Tennessee Medicaid False Claims Act (TMFCA), T.C.A. §§ 71-5-181 et seq., if the state proceeds with an action, the whistleblower is entitled to receive between 15% and 25% of the proceeds of the action or settlement, depending upon the extent to which the person substantially contributed to the prosecution of the action. If the state does not proceed with an action, the whistleblower is entitled to receive between 25% and 30% of the proceeds of the action or settlement.
In both cases, the whistleblower is also entitled to receive an amount for reasonable expenses that the court finds to have been necessarily incurred, plus reasonable attorneys' fees and costs.
Help safeguard our nation’s health care programs for future generations. If you suspect your Tennessee health care employer is guilty of Medicaid Fraud, you are protected by federal and state whistleblower laws and may be entitled to a substantial cash award for your information. Contact the Medicaid Fraud Hotline Now.
Are There Time Limits for Reporting Tennessee Medicaid Fraud?
Under the Tennessee Medicaid False Claims Act (TMFCA), T.C.A. §§ 71-5-181 et seq., a civil action must be brought:
- Within 6 years of the date on which the violation is committed, or
- Within 3 years of the date when facts material to the right of action are known or reasonably should have been known by the official of the state charged with responsibility to act in the circumstances, but
- In no event more than 10 years after the date on which the violation is committed, whichever occurs last.
Whistleblowers must bring actions under the anti-retaliation provision of the TMFCA within 3 years of the date when the retaliation occurred.
Under Tenn. Code. Ann. § 8-50-116, any state employee injured by employee retaliation must maintain an action within 1 year of the alleged violation.
The government’s ability to recover stolen Tennessee Medicaid funds depends on whistleblowers coming forward. The U.S. government recovered nearly $3 billion dollars in 2014 as a result of whistleblowers reporting health care fraud. These whistleblowers were awarded over $435 million in cash as a result of their disclosures. Call today to learn if your information makes you eligible for a whistleblower cash award.
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