§ 71-5-2603. Fraud Reporting Requirements — Immunity From Liability
All managed care organizations, contractors, subcontractors, providers or any other person or entity shall advise the office of TennCare inspector general immediately when there is actual knowledge, not subject to a testimonial privilege, that an act of recipient, enrollee, or applicant fraud is being, or has been committed. The office of TennCare inspector general shall […]
§ 71-5-2604. Administrative Remedies — Recovery of Costs — Contested Cases — Rules and Regulations — Final Orders
Without regard to any other civil or criminal liability that might attach, by operation of this section or any other law, the office of inspector general shall have an administrative remedy against an enrollee, recipient, applicant, or person purporting to be an enrollee, recipient, or applicant, who improperly obtains medical assistance benefits or any assistance […]
§ 71-5-181. Tennessee Medicaid False Claims Act — Short Title
71-5-188. Actuarial study of TennCare. 71-5-1308. Administration of part.
§ 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 […]
§ 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 […]