§ 71-5-2517. Authority to Require Periodic Provision of Specific Data — Compliance — Format of Data — Charge for Supplying Data — Sufficient Dedicated Storage Space and Access to Software — Construction
The office of inspector general is authorized to require periodic provision of specific categories, types, or collations of data without the necessity of issuing a new request at the commencement of each period. Compliance with a request by the office of inspector general is not dependent on approval by the bureau of TennCare, and it […]
§ 71-5-2518. Rules and Regulations
The inspector general shall have authority to promulgate rules and regulations pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, as are necessary to implement §§ 71-5-2513 — 71-5-2521. The rules shall be promulgated as emergency rules. The inspector general is designated as the agency person to review initial orders and […]
§ 71-5-2519. Written Petition for Objection to Providing Access to Data — Enforcement of Obligations
A person or entity requested to provide access to data pursuant to §§ 71-5-2513 — 71-5-2521 may object to providing all or part of such access by filing a written petition with the inspector general within thirty (30) days of receipt of notice of the request to which objection is made. The petition shall be […]
§ 71-5-2520. Collections of Penalties, Fees and Costs
All funds collected as civil penalties, attorney’s fees, costs, or costs of investigation by the inspector general, pursuant to this part or part 26, shall be deposited by the state treasurer in a separate account exclusively for the use of that office to defray the expenses of continued operations involving recipient fraud and abuse, including, […]
§ 71-5-2521. Report
The office of inspector general shall include in its annual report information on the progress of its data mining efforts, including any difficulties encountered in obtaining access to data from either private or government entities, and suggestions for legislative or other solutions.
§ 71-5-2507. Enforcement by Law Enforcement Officers
The staff of the office of inspector general may include law enforcement officers, as defined in § 39-11-106(a) and qualified as defined in § 38-8-106, who have successfully completed a training course approved by the Tennessee peace officer standards and training commission, including surveillance training. Any duly authorized law enforcement officer who has been specifically […]
§ 71-5-2508. Medicaid Fraud Control Unit
There is established a medicaid fraud control unit, which is separate and distinct from the state medicaid agency, within the criminal investigation division of the Tennessee bureau of investigation or within another appropriate agency at the discretion of the governor. As regulated by federal law, the unit is authorized to investigate and refer for prosecution […]
§ 71-5-2509. Powers When Investigating Fraud or Abuse — Judicial Enforcement
The office of inspector general, when conducting any investigation relating to TennCare fraud or abuse, shall have the power to issue subpoenas, and compel the attendance of witnesses, the examination of such witnesses under oath, and the production of books, accounts, papers, records, and documents relating to such investigation. In the case of a failure […]
§ 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.
§ 71-5-2511. Annual Reports
The inspector general shall annually report by October 1 of each year for the prior fiscal year to the governor and the general assembly on the activities of the inspector general’s office. The report shall include actual numbers of complaints, investigation, charges, prosecutions, convictions and appeals. The director of the Tennessee bureau of investigation shall […]