Medicaid Fraud Control Unit

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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 violations of all applicable laws pertaining to provider or vendor fraud and abuse in the administration of the medicaid program, the provision of goods or services or the activities of providers of goods or services under the state medicaid plan; medicare fraud; and abuse or neglect in healthcare facilities receiving payments under the state medicaid plan, such as board and care facilities as allowed by federal law. A summary of the unit's work shall be included in a report which shall be submitted annually to the governor, judiciary committee of the senate, and committee of the house of representatives having oversight over TennCare.


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