§ 71-5-2512. Cash Reward Program for Reporting Criminal Fraud by Recipients of the Tenncare Program
The office of inspector general shall establish an incentive program to provide a cash reward to citizens who notify the office of inspector general of criminal fraud by recipients of the TennCare program. The cash reward shall be paid if the information provided by the citizen results in a criminal conviction. Such cash awards shall […]
§ 71-5-2513. Legislative Intent
The general assembly recognizes that data mining is an important tool that should be used for the detection of fraud and abuse in the TennCare program; therefore, it is the intention of the general assembly that: The office of inspector general shall engage in data mining relating to the receipt of medical assistance and any […]
§ 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 […]
§ 71-5-2504. 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 […]
§ 71-5-2506. Fraud and Abuse Cases
The office of inspector general shall have the authority to provide legal assistance to the attorney general and reporter and the state district attorneys general for the purpose of initiating and handling proceedings in appropriate TennCare fraud and abuse cases. Such assistance may include but not be limited to, the authority to fund assistant attorney […]
§ 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. […]