§ 71-5-2514. Definitions
As used in §§ 71-5-2513 — 71-5-2521, unless the context otherwise requires: “Access” means the ability to extract intelligible information through automated means, and to store, retrieve, use, and otherwise manipulate that information in a way that may lead to meaningful analysis with the aid of commonly available computer software and hardware; “Data” means representations […]
§ 71-5-2515. Data Provided to the Inspector General
All persons and entities under contract with the TennCare bureau or its agent or designee, including, but not limited to, all managed care organizations, benefit managers, and other managed care contractors, shall promptly provide to the office of inspector general, on request: A copy of, or access to, the same data regularly provided to the […]
§ 71-5-2516. Confidentiality — Liability for Providing Data — Creation of New Records or Data — Destruction of Data
All records obtained pursuant to this chapter shall be treated as confidential investigative records of the office of inspector general and shall not be open to public inspection; provided, however, that nothing in this part shall be construed to affect the obligation of the single state agency under federal law to provide the medicaid fraud […]
§ 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 […]
§ 71-5-2501. 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 […]