Medicaid Fraud

Medicaid Fraud

In Tennessee, TennCare provides vital Medicaid services to some of the state's most vulnerable residents. TBI's dedicated Agents in its Medicaid Fraud Control Unit provide a layer of protection and accountability to ensure the spending of those funds is legal and appropriate. Furthermore, the TBI works to ensure those treated using TennCare funds receive safe, quality care.

The TBI investigates two types of Medicaid Fraud cases: provider fraud and patient abuse.

Examples of Medicaid Fraud can include:

  • Billing for medical services not actually performed
  • Billing for a more expensive service than was actually rendered
  • Billing twice for the same medical service
  • Dispensing generic drugs and billing the Managed Care Organization for expensive brand-name drugs
  • Kickbacks: Giving or accepting something in return for medical services
  • Abuse or neglect of patients in facilities receiving funds from TennCare
  • Bribery 

To report TennCare provider fraud or patient abuse in Tennessee, call the TBI's Medicaid Fraud Control Unit Hotline: 1-800-433-5454. You can also contact TBI by sending a message to TipsToTBI@tn.gov.