TennCare’s Fraud Investigations Unit Could Nearly Double In Size

Gov. Bill Lee wants to nearly double the size of TennCare’s fraud unit.

He proposed the expansion during this week’s State of the State address as part of a way to cut health care costs.

The governor’s budget would add 26 positions — 24 investigators and two nurses — to a unit that’s had the same size staff of roughly 37 people for the last two decades, even as the TennCare budget has more than doubled beyond $12 billion.

The positions are mostly funded by the federal government, as is TennCare. And for every dollar spent on investigators, they recover about $11 on average, according to state officials. Investigators often give out infractions for 
illegally obtaining prescription drugs or
impersonating a Tennessee resident. The office even keeps up a
“most wanted” list online.

Investigators also
look for abuse by providers over-billing the TennCare program, like a Chattanooga pediatrician
who just settled with the state.

Lee says the expansion should actually save the state money.

“These efforts will place downward pressure on the cost of coverage,” he said Monday night.  

The Medicaid Fraud Control Unit is housed within the Tennessee Bureau of Investigation, which says the team has been understaffed by comparison to others in the region.

“The investment will put Tennessee on par with many of our surrounding states, giving us the potential to better ensure our state recovers our fair share of the millions paid out in Medicaid settlements every year,” TBI director David Rausch said in a statement.