TennCare Strengthens Fraud, Enrollment Verification Unit

Despite the state's budget crunch, TennCare, Tennessee's Medicaid managed care program, plans to double the staff of its Program Integrity Unit, which investigates TennCare abuse, the Chattanooga Times & Free Press reports. With 22 investigators expected to be working for the unit before the end of the year, the unit has been divided into five "primary divisions." The largest division will investigate whether workers with access to employer-sponsored coverage are improperly enrolled in TennCare. The second-largest division will verify the "accuracy" of reported incomes and determine if enrollees have moved out of state or have died. A third division will remove members who have become ineligible for coverage through incarceration and will identify medical bills of beneficiaries injured on the job or in auto accidents that should be covered by workers' compensation or auto insurance. A fourth division will examine "provider fraud," such as overbilling, while the fifth and final division will investigate "enrollee abuse," such as prescription drug abuse. Program Integrity Unit Director Tom Mathis said, "I believe [the unit] ... will return $10 for every dollar the state spends" (Park/Flessner, Chattanooga Times & Free Press, 11/5). For data and other information on health in the states mentioned in today's Kaiser Daily Health Policy Report, visit State Health Facts Online.