§ 71-5-2510. Investigations of Fraud or Abuse Involving Managed Care Organizations
Notwithstanding any other provision of this chapter or of title 38, the Tennessee bureau of investigation and the office of inspector general are authorized to investigate allegations of fraud or abuse involving TennCare managed care organizations.
§ 71-5-2401. Establishment — Members — Recommendations Concerning Drugs on Auto-Exemptions List
There is established in the department of finance and administration a state TennCare pharmacy advisory committee. The committee shall make recommendations regarding a preferred drug list (PDL) to govern all state expenditures for prescription drugs for the TennCare program. The state TennCare pharmacy advisory committee shall be composed of fifteen (15) members. Except for initial […]
§ 71-5-2402. Removal of Member
A state TennCare pharmacy advisory committee member shall be removed by the commissioner of finance and administration from the committee for any of the following causes: Absence from two (2) consecutive meetings without contacting the chair or the vice chair with a satisfactory explanation; Absence from three (3) meetings in a single year without contacting […]
§ 71-5-2403. Conflicts of Interest — Compensation
Members of the state TennCare pharmacy advisory committee shall not enter any financial relationships with pharmaceutical manufacturers or their affiliates during their tenure on the state TennCare pharmacy advisory committee. A member shall not entertain individual lobbying or marketing, or participate in any other activity or discussions with pharmaceutical manufacturers or their representatives for the […]
§ 71-5-2404. Recommendations for Inclusion on Preferred Drug List
The TennCare pharmacy advisory committee shall submit to the bureau of TennCare both specific and general recommendations for drugs to be included on any state preferred drug list (PDL) adopted by the bureau. In making its recommendations, the committee shall consider factors including, but not limited to, efficacy, the use of generic drugs and therapeutic […]
§ 71-5-2501. Short Title
This part shall be known and may be cited as “The TennCare Fraud and Abuse Reform Act of 2004”.
§ 71-5-2502. Office of Inspector General
There is created a division of state government which shall be known and designated as the office of inspector general. This division shall be located within the department of finance and administration and shall report directly to the commissioner of finance and administration. The office of inspector general shall be headed by an inspector general. […]
§ 71-5-2503. Part Definitions
As used in this part and part 26 unless the context otherwise requires: “Abuse” shall be given the same meaning as currently exists in federal regulations located at 42 CFR 455.2, with the following exceptions: It shall also apply to practices by vendors or other persons or entities; and It shall also apply to the […]
§ 71-5-2504. Rules and Regulations
The commissioner is authorized to promulgate rules and regulations, including emergency rules pursuant to § 4-5-208, to effectuate the purposes of this part. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
§ 71-5-2505. Authority
The office of inspector general shall have the authority to: Investigate civil and criminal fraud and abuse of the TennCare program, or any other violations of state criminal law related to the operation of TennCare; Cooperate with the MFCU, and where a preliminary investigation of fraud and abuse by a provider establishes a sufficient basis […]