The Federal Civil False Claims Act (FCA), the Tennessee False Claims Act (TFCA) and Tennessee Medicaid False Claims Act (TMFCA) are laws that impose civil liability on any person who knowingly:

• presents, or causes to be presented, a false or fraudulent claim, record or statement for payment or approval,
• conspires to defraud the government by getting a false or fraudulent claim allowed or paid,
• uses a false record or statement to avoid or decrease an obligation to pay the Government, and
• other fraudulent acts enumerated in the statute.

Examples of a possible false claim

1. Making false statements regarding a claim for payment;
2. Falsifying information in the medical record;
3. Billing twice for the same items or services provided;
4. Billing for services or items not performed or never furnished

If you become aware of such abuses, fraud or waste, you may report the event to Jeff Fox, Compliance and Quality Assurance Manager, 615-781-3000, for further investigation. If you are not comfortable doing this you may report the suspected fraud to external agencies such as the State of Tennessee Comptroller's hot-line (1-800-232-5454), the Tennessee Department of Finance and Administration's Office of Inspector General (OIG) fraud and abuse hot-line (1-800- 433-3982) and the Tennessee Bureau of Investigation (TBI) Medicaid fraud hot-line (1-800-433- 5454)

AGAPE
4555 Trousdale Drive
Nashville, Tennessee 37204

I acknowledge that I have received information regarding AGAPE's efforts to avoid fraud, waste and abuse. I understand that I have an obligation to report any concerns I have regarding any instances whereby fraud, waste or abuse of government funding may be occurring.

I understand that I may file a complaint with Jeff Fox, Compliance and Quality Assurance Manager, AGAPE, 615-781-3000, 4555 Trousdale Drive, Nashville, Tennessee, 37204, who will initiate an investigation, or I can make a report directly to the State of Tennessee Comptroller's hot-line (1-800-232-5454), the Tennessee Department of Finance and Administration's Office of Inspector General (OIG) fraud and abuse hot-line (1-800-433-3982) and the Tennessee Bureau of Investigation (TBI) Medicaid fraud hot-line (1-800-433-5454