NASHVILLE, Tenn. — Vanderbilt University Medical Center notified transgender patients it handed medical records over to Attorney General Jonathan Skrmetti's office, in what the office said was an investigation into possible medical billing fraud.
According to the Associated Press, "complete copies" of patient medical records that were relevant to the investigation were handed over. The Attorney General's Office said it had been investigating possible medical billing fraud by the hospital and other providers since at least September 2022. They said the hospital started providing patient records in December 2022.
"Why can't you just use redacted records? Why do you need the patient's name, date of birth, all of their information?" said Ray Holloman, chair of the Tennessee Transgender Task Force. "It seems like you're trying to figure out who's reaching out to Vanderbilt, maybe get gender-affirming care, whether it was at Vanderbilt or somewhere else, whether they received it in the state or not."
Skrmetti said that in the summer of 2022, his office heard a VUMC doctor manipulated medical billing codes to evade coverage limitations on "gender-related treatment." On May 24, the state was sued in a lawsuit claiming the state's healthcare exclusions discriminate against transgender people.
He also said the transgender patient's records were not provided as part of a separate lawsuit over the state's ban on gender-affirming healthcare for transgender youth. However, the lawsuit revealed the office's Civil Investigative Demand on VUMC, which required them to turn over the documents.
"Not every trans person is out in their lives. Some people choose to be stealthy for a lot of different reasons. Obviously, we live in a very hostile state, so if this information gets into the wrong people's hands, this could be detrimental to people's employment, to their family relationships," said Holloman. "What's the possibility that this could be part of a list-building conversation? We've seen this happen in other states where they've used different means to try to build lists of transgender people, and so this could just be their first attempt of trying to do something like that."
He said patients should ask VUMC for a copy of what was provided for the Attorney General's office, and said people could file a complaint with the Department of Human and Health Services.
"You're already struggling with your sense of self, and going through this transition. And now, it feels like you've been kind of put in the spotlight — you've been really exposed in a way that you weren't expecting to be exposed," he said. "It's just created a lot of anxiety because they don't know who as the information, who has the ability to see the information. Is it going to potentially, you know, maliciously be released? It's just creating a lot of anxiety."
The Attorney General's Office released a statement about the investigation. It's available in full below.
In the summer of 2022, the Attorney General’s Office learned that a VUMC doctor publicly described her manipulation of medical billing codes to evade coverage limitations on gender-related treatment. That information provided predication for an investigation into potential violation of the Tennessee Medicaid False Claims Act (TMFCA) and the Tennessee False Claims Act (TFCA). The Office formally opened its investigation into VUMC and certain related providers last September.
This Office is charged with enforcing the TMFCA and TFCA. The Attorney General investigates and litigates numerous medical billing fraud cases every year. The Office’s Civil Medicaid Fraud Unit regularly works with various state and federal authorities to investigate potential fraud and enforce these statutes. This is standard practice not just in Tennessee but nationwide. The Civil Medicaid Fraud Unit regularly recovers millions of dollars a year from providers who defrauded state funds.
To enforce the TMFCA and TFCA, the Attorney General is authorized to issue civil investigative demands (CIDs), which may require sworn testimony and document production, including patient medical records. This is the same legal tool regularly employed in consumer protection investigations of other types of corporate misconduct. Every TMFCA investigation necessarily requires reviewing patient medical records in conjunction with medical billing claims. The Office is legally bound to maintain the medical records in the strictest confidence, which it does.
VUMC started producing medical records more than six months ago. This Office has kept the investigation confidential for almost a year and was surprised by VUMC's decision to notify patients. The Attorney General has no desire to turn a run-of-the-mill fraud investigation into a media circus.
The plaintiffs in the L.W. v. Skrmetti case used their own legal discovery tools to obtain this Office's communications with VUMC. In response to that discovery request this Office was obligated to produce the CIDs sent to VUMC, but did not provide any patient information or records.
We understand patients are concerned that VUMC produced their records to this Office, especially when those patients received abrupt notice without any context. To reiterate, this investigation is directed solely at VUMC and related providers and not at patients or their families. The records have been and will continue to be held in the strictest confidence, as is our standard practice and required by law. This same process happens in dozens of billing fraud investigations every year.
The House Democratic Caucus Chair, John Ray Clemmons, already released a statement about the request for transgender patients' records. It is available below as well.
House Democratic Caucus Chair John Ray Clemmons says that Tennessee Attorney General Jonathan Skrmetti is widely deviating from the duties of his office, as required by law, and improperly using the office to advance a personal, political agenda. This comes after a series of politically partisan actions by the Attorney General, including recent reports that he has required Vanderbilt University Medical Center to disclose confidential medical records and health care providers' employment records.
While the AG's office alleges to be investigating billing fraud, it is reportedly using Criminal Investigative Demands (CID) to obtain a wide range of records, most of which appear to have little to no relevance to a civil fraud case against a leading healthcare facility and its providers. According to The Tennessean, the AG's three rounds of far-reaching CID demands include documents such as Vanderbilt employment contracts, resumes, IRS forms and employee lists, in addition to a range of other documents.
Chairman Clemmons says, “Given the specialty areas General Skrmetti is targeting, his actions give the appearance that he is improperly weaponizing and abusing the broad CID powers of the Attorney General's office to carry out an intimidation campaign against one of our state’s preeminent healthcare facilities and its providers and patients for the purpose of promoting his own radical political agenda or that of an extremist faction within his political party. When you consider that he purposefully entered this personal and private information into the public record, it seems he intentionally created a significant threat to medical professionals and their patients' privacy and safety.”
Clemmons says this latest conduct is only a continuation of the “politically partisan manner in which Jonathan has conducted himself since day one.” In addition to Skrmetti's records request that “arguably extend well beyond the scope of a Medicaid fraud case,” Skrmetti has within just the last few weeks:
- Headlined an event hosted by IWN, an ultra-conservative women’s group, titled "We Know What a Woman Is" to praise new discriminatory state laws.
- Used state resources and personnel to promote a fundraising campaign for anti-abortion “crisis pregnancy centers” to celebrate the anniversary of the Dobbs decision. Skrmetti, along with the Mississippi Attorney General, is co-hosting the fundraising efforts and has even posted a link to the "pregnancy centers" wish lists on a state website.
- Additionally, since taking office last September, Skrmetti notably unnecessarily entered into an Agreed Order in a federal lawsuit filed by a California gun rights group to overturn a state law regarding firearms permits.
- Unnecessarily involved his office in a suit involving a Kentucky wedding photographer who refused to perform services for a same-sex wedding.
- Unnecessarily supported a Texas lawsuit seeking to overturn a rule allowing the Department of Veteran Affairs to provide access to abortions and abortion counseling for veterans.
- Unnecessarily joined a Texas lawsuit challenging the Biden Administration’s border patrol policies.
- Unnecessarily joined yet another lawsuit against Yelp that would end a disclaimer the online company uses on advertisements for “crisis pregnancy centers.”
- Unnecessarily filed a brief supporting Florida’s ban on using Medicaid funds for gender transition procedures.
- And is even using taxpayer money to beef up his office, adding a 10-attorney “strategic litigation unit” to continue fighting for what Skrmetti calls “proactive litigation.”
Chairman Clemmons adds, “I’m of the opinion that a sitting Attorney General should be solely focused on promoting the rule of law and carrying out his statutory duties. Nowhere among the dozens of statutes in the Tennessee Code is there an authorization for the Attorney General to use taxpayer resources and his office to promote his own political agenda or that of his political party. Our state does not elect its Attorney General for a clear reason, and Skrmetti's questionable conduct defeats the very purpose for our Supreme Court's selection of the individual who serves in this important role. What Jonathan is doing is beneath the dignity of the office.”
VUMC said they did not have any additional comment on the investigation.