Criminal Investigation Division

To Report TennCare Provider Fraud or Patient Abuse in Tennessee call TBI’s Medicaid Fraud Control Unit Hotline: 1-800-433-5454 or Email TIPs to TBI

Patient and Elder Abuse

Residents of mental health facilities and elderly persons living in nursing homes are all too often the victims of physical, emotional, sexual and financial abuse. Neglecting these individuals can also constitute abuse.  By law, citizens who have knowledge of or suspect this kind of activity are required to notify the proper authorities. The law also protects those who report abuse from being retaliated against by their employer. 

In many cases, an abused or neglected person is totally dependent on the abuser and is afraid to complain for fear of reprisal. That's why it is especiallly important that other people watch for these warning signs and call law enforcement if they appear.  Below are some examples of each kind of abuse.

Physical Abuse:

• Frequent unexplained injuries or complaints of pain without obvious injury
  
• Burns or bruises suggesting the use of instruments, cigarettes, etc.
  
• Passive, withdrawn and emotionless behavior
  
• Lack or reaction to pain
  
• Injuries that appear after the person has not been seen for several days
  
• Reports of physical abuse
  

Sexual Abuse:

• Sexually transmitted diseases
  
• Injury to the genital area
  
• Difficulty in sitting or walking
  
• Fear of being alone with caretakers
  
• Reports of sexual assault
  

Neglect:

• Obvious malnutrition
  
• Lack of personal cleanliness
  
• Habitually dressed in torn or dirty clothes
  
• Obvious fatigue and listlessness
  
• Begs for food
  
• In need of medical or dental care
  
• Left unattended for long periods
  
• Reports neglect
  

Examples of Medicaid Fraud

• 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 MCO 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