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The Tennessee Office of lnspector General was created in 2004 by the TennCare Fraud and Abuse Reform Act, Tenn.CodeAnn. 71-5-2502. In the preamble
to that act, the General Assembly "declare[d] it to be public policy of the State of Tennessee that TennCare fraud and abuse be
identified and dealt with aggressively and appropriately." The mission of the OIG
is to identify, investigate, and prosecute persons
who commit fraud against TennCare.
The Inspector General is appointed by the Governor and reports directly to the Commissioner of Finance and Administration.
Under the Reform Act and subsequent legislation, the OIG is authorized to
- investigate civil and criminal fraud and abuse of the TennCare and CoverTN programs, or any other violations of state criminal
law related to the operation of TennCare and CoverTN, including allegations of fraud or abuse involving TennCare and CoverTN
managed care organizations (MCOs)
- cooperate with the Medicaid Fraud Control Unit at the Tennessee Bureau of investigation and refer instances of provider fraud
and abuse to that unit
- furnish the public with information about the fraud and abuse laws pertaining to TennCare and CoverTN
- provide legal assistance to the Attorney General and the District Attorneys general in initiating and handling proceedings in
appropriate TennCare and CoverTN fraud and abuse cases, including criminal prosecutions, civil recoveries, and forfeitures
- employ qualified law enforcement officers with authority to enforce the fraud provisions
- pay cash rewards to citizens who provide information regarding TennCare and CoverTN fraud which leads to a criminal
conviction
- subpoena witnesses and records in connection with any investigation into TennCare and CoverTN fraud or abuse
In addition to establishing the OIG and setting forth its authority, the Reform Act also created specific TennCare and CoverTN
fraud offenses which were intended to punish activities that had largely escaped prosecution under existing law.
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