The State of Tennessee sues Franklin healthcare clinic in TennCare fraud case

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Posted at 5:27 PM, Apr 10, 2019
and last updated 2019-04-10 18:27:51-04

The U.S. District Court for the Middle District of Tennessee has made a public suit against ProHealth Rural Health Services, Inc. and its president and CEO, Ray White. The suit was filed by Attorney General Herbert H. Slatery.

As a Federally Qualified Community Health Center (FQHC) Look-Alike, ProHealth - located in Franklin - provides healthcare to all patients, whether they can pay or not. That entitles ProHealth to receive prospective payment service (PPS) payments. PPS payments are a guaranteed minimum amount of money paid for each Medicaid patient visit.

According to the Attorney General's office, it is alleged White knowingly submitted invoices to the State of Tennessee falsely inflating the number of Medicaid patients who visited ProHealth from 2012 to 2017. Because of those invoices, TennCare paid ProHealth more than $6 million that it was not supposed to receive.

"ProHealth abused its status as a FQHC to make millions of dollars for services it did not provide to patients who never even walked in the door," said Attorney General Slatery. "That's why the state is seeking the maximum penalty allowed by law. We want to send a very clear message - TennCare fraud will not be tolerated."

The state of Tennessee is seeking over $18 million in damages under the Tennessee Medicaid False Claims Act, as well as $440,000 in fines.

You can read the full complaint of the suit here.