§ 71-5-2501 Short title
§ 71-5-2502 Office of inspector general
§ 71-5-2503 Part definitions
§ 71-5-2504 Rules and regulations
§ 71-5-2505 Authority
§ 71-5-2506 Fraud and abuse cases
§ 71-5-2507 Enforcement by law enforcement officers
§ 71-5-2508 Medicaid fraud control unit
§ 71-5-2509 Powers when investigating fraud or abuse – Judicial enforcement
§ 71-5-2510 Investigations of fraud or abuse involving managed care organizations
§ 71-5-2511 Annual reports
§ 71-5-2512 Cash reward program for reporting criminal fraud by recipients of the TennCare program
§ 71-5-2513 Legislative intent
§ 71-5-2514 Definitions
§ 71-5-2515 Data provided to the inspector general
§ 71-5-2516 Confidentiality – Liability for providing data – Creation of new records or data – Destruction of data
§ 71-5-2517 Authority to require periodic provision of specific data – Compliance – Format of data – Charge for supplying data – Sufficient dedicated storage space and access to software – Construction
§ 71-5-2518 Rules and regulations
§ 71-5-2519 Written petition for objection to providing access to data – Enforcement of obligations
§ 71-5-2520 Collections of penalties, fees and costs
§ 71-5-2521 Report
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Terms Used In Tennessee Code > Title 71 > Chapter 5 > Part 25 - Tenncare Fraud and Abuse

  • Benefits: means the health care package of services available to TennCare enrollees. See Tennessee Code 71-5-2503
  • Commissioner: means the commissioner of finance and administration. See Tennessee Code 71-5-2503
  • Contract: A legal written agreement that becomes binding when signed.
  • Conviction: A judgement of guilt against a criminal defendant.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Department: means the department of finance and administration. See Tennessee Code 71-5-2503
  • Dependent: A person dependent for support upon another.
  • Enrollee: means an individual eligible for and enrolled in the TennCare program or in any successor medicaid program in Tennessee. See Tennessee Code 71-5-2503
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • 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
  • Fraud: Intentional deception resulting in injury to another.
  • Inspector general: means the person who directs the office of inspector general, who shall report directly to the commissioner of finance and administration. See Tennessee Code 71-5-2503
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • Medical assistance: means payment of the cost of care, services and supplies necessary to prevent, diagnose, correct or cure conditions in the person that cause acute suffering, endanger life, result in illness or infirmity, interfere with the person's capacity for normal activity, or threaten some significant disability and which are furnished an eligible person in accordance with the rules, regulations, and statutes governing TennCare. See Tennessee Code 71-5-2503
  • MFCU: means the medicaid fraud control unit. See Tennessee Code 71-5-2503
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Person: includes a corporation, firm, company or association. See Tennessee Code 1-3-105
  • 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
  • Public defender: Represent defendants who can't afford an attorney in criminal matters.
  • Recipient: means any person who has been determined eligible to receive benefits under part 1 of this chapter, and who has received such benefits. See Tennessee Code 71-5-2503
  • Record: means information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in a perceivable form. See Tennessee Code 1-3-105
  • Reporter: Makes a record of court proceedings and prepares a transcript, and also publishes the court's opinions or decisions (in the courts of appeals).
  • Representative: when applied to those who represent a decedent, includes executors and administrators, unless the context implies heirs and distributees. See Tennessee Code 1-3-105
  • 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
  • Subpoena: A command to a witness to appear and give testimony.
  • TennCare: means the program administered by the single state agency, as designated by the state and CMS, pursuant to Title XIX of the Social Security Act ( 42 U. See Tennessee Code 71-5-2503
  • 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
  • Venue: The geographical location in which a case is tried.
  • written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
  • Year: means a calendar year, unless otherwise expressed. See Tennessee Code 1-3-105