Orthopedic practice to pay $540K+ to resolve billing claims

Practice Management

Memphis, Tenn.-based Tri-State Orthopaedics agreed to pay more than $540,000 to resolve allegations it improperly billed TennCare, Tennessee's Medicaid program, the state's attorney general's office said Jan. 24.

The practice allegedly purchased a compound version of triamcinolone acetonide from compounding pharmacies and billed TennCare for the higher cost, FDA-approved version of the injectable, according to a news release. 

TennCare requires practices to go through prior authorization to use and bill for compounded drugs, along with documenting medical reasons for using compounded drugs and their ingredients.

The alleged billing fraud happened from Feb. 6, 2019, through Nov. 17, 2021. The practice allegedly received higher reimbursement rates from TennCare than entitled.

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