Tennessee Code 71-5-2508 – Medicaid fraud control unit
Terms Used In Tennessee Code 71-5-2508
- Fraud: Intentional deception resulting in injury to another.
- Fraud: means an intentional deception or misrepresentation made by a person including, but not limited to, a vendor, recipient, provider, or enrollee, with the knowledge that the deception or misrepresentation could result in some unauthorized benefit or payment to oneself or some other person. See Tennessee Code 71-5-2503
- Property: includes both personal and real property. See Tennessee Code 1-3-105
- Provider: means an institution, facility, agency, person, corporation, partnership, unincorporated organization, nonprofit organization or any person or entity directly or indirectly providing benefits, goods or services to a TennCare enrollee. See Tennessee Code 71-5-2503
- State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
- Vendor: means any person, institution, agency, other entity or business concern providing services or goods authorized under chapter 5, part 1 of this title, and includes, but is not limited to, any health maintenance organization, managed care organization, managed care contractor, administrative services organization, pharmacy benefit manager, prepaid limited health service organization, contractor or subcontractor. See Tennessee Code 71-5-2503
There is established a medicaid fraud control unit, referred to as the medicaid fraud control division, which is separate and distinct from the state medicaid agency, and is within 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; abuse, neglect, and misappropriation of funds or property in healthcare facilities receiving payments under the state medicaid plan and in board and care facilities as allowed by federal law; and complaints of abuse, neglect, and financial exploitation of medicaid recipients in any setting. A summary of the unit’s work shall be included in a report which must be submitted annually to the governor, judiciary committee of the senate, and criminal justice committee of the house of representatives.