Authority

  1. Law
  2. Tennessee Code
  3. Welfare
  4. Programs and Services for Poor Persons
  5. Tenncare Fraud and Abuse
  6. Authority

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The office of inspector general shall have the authority to:

  1. 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;
  2. Cooperate with the MFCU, and where a preliminary investigation of fraud and abuse by a provider establishes a sufficient basis to warrant a full investigation, refer such matters to the MFCU;
  3. Refer matters to the appropriate enforcement authority for criminal prosecution;
  4. Refer matters to the appropriate enforcement authorities for civil proceedings, and assist in the recovery of funds which have been inappropriately paid by the TennCare program, including, but not limited to, referral to the attorney general and reporter for civil recovery;
  5. Cooperate with the appropriate federal departments in any reasonable manner as may be necessary to qualify for federal aid in connection with TennCare;
  6. Cooperate with the federal government and other state governments to investigate TennCare and medicaid fraud and abuse;
  7. Cooperate with other state agencies to investigate TennCare and medicaid fraud and abuse;
  8. Within sixty (60) days after the close of each fiscal year, prepare and print a summary report, which shall be submitted to the governor, members of the general assembly, the committee of the house of representatives having oversight over TennCare, the TennCare advisory commission, and the commissioner. This report shall include a summary of all activities of the office of inspector general during that fiscal year;
  9. Furnish information to acquaint the public with the fraud and abuse laws pertaining to TennCare;
  10. Contract with necessary entities to carry out the required duties of this part. All such contracts shall be procured in accordance with the requirements of title 12, chapter 4, part 1; and
  11. Exercise any additional powers necessary to carry out the purposes and provisions of this part.


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