Tennessee is aggressive with health care fraud, often mistakenly

On Behalf of | Mar 24, 2023 | Health Insurance & Medicare Fraud |

Health care coverage is a concern for people throughout Tennessee. With medical expenses for illnesses, conditions and injuries often rising in rapid fashion, having insurance is essential. In some instances, however, people are accused of committing fraud either when getting coverage or using it. In some cases, the medical provider is accused of billing violations.

Being accused of fraud in any way can negatively impact a person’s life in just about every way. They can face incarceration, fines and face the aftermath of having a criminal record when they try to find jobs and improve their lives. In some instances, the allegations are overblown or just plain wrong. Regardless of the circumstances, it is essential to know the value of a strong criminal defense.

Mistakes with Medicaid can make people targets for law enforcement

In Tennessee, the Medicaid program is known as TennCare. Recently, there have been reports of individuals who use the program being accused of fraud. In fact, the state posts people’s names on social media, government sites and even has a “most wanted list” of those categorized as committing the most egregious forms of health care fraud.

The original objective, according to the Office of the Inspector General, was to pursue those who were using their benefits to get prescription medications to sell. As federal laws reduced the frequency of these crimes, the fraud investigations started pursuing people who were alleged to have left the state but kept their benefits.

One woman, 42, had her life upended by these allegations. Eventually, they were revealed as a clerical mistake because of her divorce. She was facing felony charges until proving that she still lived in Tennessee. Many of the health care fraud cases are based on this type of situation. Often, there is a logical explanation. Despite that, people who have warrants might be arrested immediately and not know why.

For health care or insurance fraud, customized legal help can make a major difference

These cases can be complicated and having legal assistance from a lawyer who knows how to combat the charges with specific experience in Medicare, TennCare and more can be a key to reaching a positive outcome. This applies to individuals who were covered and using the health care insurance or medical professionals who provide care and seek reimbursement from insurers.

Whether there was a mistake, misunderstanding or the charges were brought for other reasons, the repercussions can be severe. It is vital to have immediate help to assess the case, look at the evidence and move forward. Calling professionals who are experienced in health care fraud is a wise strategy.