No need for 'media circus' in VUMC billing fraud inquiry, Tennessee AG says

After Vanderbilt University Medical Center announced June 20 it had turned over five years of medical records of patients who are minors and had received gender-affirming care at the hospital, the Tennessee attorney general's office on June 21 released a statement about its investigation into "potential violation" of both the Tennessee Medicaid False Claims Act and the Tennessee False Claims Act at VUMC.

The state said it launched its investigation in September into what it called "potential medical billing fraud" after it "learned that a VUMC doctor publicly described her manipulation of medical billing codes to evade coverage limitations on gender-related treatment." 

Further, in the statement, Tennessee Attorney General Jonathan Skrmetti said he was "surprised" by the timing of the hospital's decision to make the investigation public by notifying patients that their records had been shared with investigators because the document transfers began "more than six months ago."

"This office has kept the investigation confidential for almost a year," Mr. Skrmetti said in the statement. "The attorney general has no desire to turn a run-of-the-mill fraud investigation into a media circus."

VUMC paused performing gender affirmation surgeries on patients younger than 18 after receiving a letter of concern Sept. 28 from 60 Republican Tennessee lawmakers. They wrote that they were "alarmed by recent reports" that detailed "the surgical mutilations of minor children" at the hospital.

Becker's reached out to the hospital to ask if it has resumed these surgeries in the past nine months. VUMC responded with this statement: "Pertaining to gender-affirming care at Vanderbilt University Medical Center, we continue to fully comply with all federal and state laws and are carefully following the legal proceedings challenging the constitutionality of Tennessee's new law."

Gov. Bill Lee signed legislation March 2 banning gender-affirming healthcare for youths in the state. The law goes into effect July 1.

VUMC reported having performed gender-affirming surgical procedures on "an average of five [patients] each year between 2018 and September 2022." However, the hospital said "none of these patients were under age 16, none had received genital procedures and VUMC obtained parental consent to these procedures in all cases." 

The attorney general is authorized to request sworn testimony and documents — including patient medical records — as it conducts its investigation as part of enforcing the TMFCA and TFCA. 

"Every TMFCA investigation necessarily requires reviewing patient medical records in conjunction with medical billing claims," Mr. Skrmetti wrote, noting his office "is legally bound to maintain the medical records in the strictest confidence, which it does."




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