reglab/statecodes huggingface dataset:
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 24 - TENNESSEE TENNCARE PHARMACY ADVISORY COMMITTEE (§§ 71-5-2401 — 71-5-2404) › Section 71-5-2403 - Conflicts of interest - Compensation

(a)
Members of the state TennCare pharmacy advisory committee shall not enter any financial relationships with pharmaceutical manufacturers or their affiliates during their tenure on the state TennCare pharmacy advisory committee. A member shall not entertain individual lobbying or marketing, or participate in any other activity or discussions with pharmaceutical manufacturers or their representatives for the purpose of influencing the preferred drug list (PDL) that would call into question the member's impartiality in determining drugs to recommend for inclusion on a state PDL. Nothing in this subsection (a) shall prohibit a member from engaging in common business practices or prohibit communications to or from the member that occur in the ordinary course of the member's business or professional activities.
(b)
A conflict of interest exists when the member has a significant personal, professional, or monetary interest in a matter under consideration by the state TennCare pharmacy advisory committee. Persons being considered for membership on the state TennCare pharmacy advisory committee shall disclose if they have a real or apparent conflict of interest. Conflicts of interest may include, but shall not be limited to, being the recipient of a grant, hired as a consultant, being part of a speakers bureau, a major stock holder, or the recipient of other financial support from an organization likely to benefit financially from the outcome of the state TennCare pharmacy advisory committee's work.
(c)
Members shall dispose of matters before the committee in an unbiased and professional manner. In the event that a matter being considered by the committee presents a real or apparent conflict of interest, such members shall disclose the conflict to the chair and recuse themselves from any official action on the matter.
(d)
Members shall receive no compensation for their service on the state TennCare pharmacy advisory committee but may be reimbursed for those expenses allowed by the comprehensive travel regulations promulgated by the department of finance and administration and approved by the attorney general and reporter.
Acts 2003, ch. 350, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2501 - Short title

This part shall be known and may be cited as "The TennCare Fraud and Abuse Reform Act of 2004".
Acts 2004, ch. 673, § 20.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2502 - Office of inspector general

There is created a division of state government which shall be known and designated as the office of inspector general. This division shall be located within the department of finance and administration and shall report directly to the commissioner of finance and administration. The office of inspector general shall be headed by an inspector general. The office of inspector general shall be separate and distinct from the TennCare bureau and the medicaid fraud control unit (MFCU).
Acts 2004, ch. 673, § 20; 2005, ch. 474, §§ 8, 9.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2504 - Rules and regulations

The commissioner is authorized to promulgate rules and regulations, including emergency rules pursuant to §
4-5-208
, to effectuate the purposes of this part. All such rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Acts 2004, ch. 673, § 20; 2009, ch. 566, § 12.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2505 - Authority

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 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.
Amended by 2021 Tenn. Acts, ch. 64, s 127, eff. 3/29/2021.
Amended by 2019 Tenn. Acts, ch. 345, s 142, eff. 5/10/2019.
Acts 2004, ch. 673, § 20; 2005, ch. 474, § 8; 2006, ch. 867, § 8; 2010 , ch. 872, § 7; 2011 , ch. 410, § 6 (g).
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2506 - Fraud and abuse cases

(a)
The office of inspector general shall have the authority to provide legal assistance to the attorney general and reporter and the state district attorneys general for the purpose of initiating and handling proceedings in appropriate TennCare fraud and abuse cases. Such assistance may include but not be limited to, the authority to fund assistant attorney general or assistant district attorney general positions in those respective offices, subject to the appropriations made to the office of inspector general and the agreement of the offices concerned. The office of inspector general shall also have the authority to fund public defender positions, subject to the appropriations made to the office of inspector general and the agreement of the officers concerned. The office of inspector general may, with reasonable notice, terminate the funding of any attorney positions which the inspector general has funded in either of these offices.
(b)
Venue for civil actions involving fraud and abuse shall be in the county where the offense was committed or in Davidson County. Venue for criminal actions involving fraud and abuse shall be to the full extent permitted by the constitution of the state.
Acts 2004, ch. 673, § 20; 2005, ch. 474, § 8.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2507 - Enforcement by law enforcement officers

(a)
The staff of the office of inspector general may include law enforcement officers, as defined in §
39-11-106(a)
and qualified as defined in §
38-8-106
, who have successfully completed a training course approved by the Tennessee peace officer standards and training commission, including surveillance training.
(b)
Any duly authorized law enforcement officer who has been specifically designated by the inspector general to enforce this part is authorized and empowered to go armed while on active duty engaged in enforcing this part; and is authorized to make arrests for offenses involving criminal fraud and abuse of the TennCare program and any other violations of state criminal law related to the operation of TennCare. Any such person is also authorized and empowered to execute search warrants and do all acts incident thereto in the same manner as search warrants may be executed by sheriffs and other peace officers.
Amended by 2017 Tenn. Acts, ch. 244,s 1, eff. 5/2/2017.
Acts 2004, ch. 673, § 20; 2005, ch. 474, § 8.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2508 - Medicaid fraud control unit

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.
Amended by 2023 Tenn. Acts, ch. 88,s 1, eff. 3/31/2023.
Amended by 2021 Tenn. Acts, ch. 64, s 128, eff. 3/29/2021.
Amended by 2019 Tenn. Acts, ch. 345, s 143, eff. 5/10/2019.
Amended by 2013 Tenn. Acts, ch. 236, s 42, eff. 4/19/2013.
Acts 2004, ch. 673, § 20; 2005, ch. 474, §§ 19, 20.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2510 - Investigations of fraud or abuse involving managed care organizations

Notwithstanding any other provision of this chapter or of title 38, the Tennessee bureau of investigation and the office of inspector general are authorized to investigate allegations of fraud or abuse involving TennCare managed care organizations.
Acts 2005, ch. 157, § 2.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2511 - Annual reports

(a)
The inspector general shall annually report by October 1 of each year for the prior fiscal year to the governor and the general assembly on the activities of the inspector general's office. The report shall include actual numbers of complaints, investigation, charges, prosecutions, convictions and appeals.
(b)
The director of the Tennessee bureau of investigation shall annually report to the governor and the general assembly on the activities of the medicaid fraud control unit within the criminal investigation division. The report shall include actual numbers of complaints, investigation, charges, prosecutions, convictions and appeals.
Acts 2005, ch. 157, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2512 - Cash reward program for reporting criminal fraud by recipients of the TennCare program

(a)
The office of inspector general shall establish an incentive program to provide a cash reward to citizens who notify the office of inspector general of criminal fraud by recipients of the TennCare program. The cash reward shall be paid if the information provided by the citizen results in a criminal conviction. Such cash awards shall be set at a meaningful amount through a schedule to be established by the office of inspector general.
(b)
The office of inspector general shall furnish information to acquaint the public with the existence of the program and the means by which citizens may participate.
(c)
The commissioner of finance and administration shall use the commissioner's rule-making authority under this chapter to promulgate rules establishing the program mandated by subsection (a).
(d)
The office of inspector general shall file with the commerce and labor committee of the senate and the insurance committee of the house of representatives, by February 15 of each year, an annual report of all moneys paid to citizens pursuant to the program established by this section.
Amended by 2021 Tenn. Acts, ch. 64, s 129, eff. 3/29/2021.
Amended by 2019 Tenn. Acts, ch. 345, s 144, eff. 5/10/2019.
Amended by 2013 Tenn. Acts, ch. 236, s 19, eff. 4/19/2013.
Acts 2005, ch. 474, § 26.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2513 - Legislative intent

The general assembly recognizes that data mining is an important tool that should be used for the detection of fraud and abuse in the TennCare program; therefore, it is the intention of the general assembly that:
(1)
The office of inspector general shall engage in data mining relating to the receipt of medical assistance and any assistance paid for by TennCare on behalf of recipients, for the purpose of detecting fraud or abuse by recipients;
(2)
The inspector general shall have prompt, continuing, and effective access to all such data in a manner that will permit effective data mining for these purposes without imposing unduly burdensome or oppressive requirements on persons or entities that provide medical assistance or any assistance paid for by TennCare; and
(3)
Data mining by the office of the inspector general is not intended to alter the requirements under Title XIX of the federal Social Security Act (
42 U.S.C. § 1395
et seq.), including, but not limited to, the requirements that the single state agency designated to administer the medicaid program must have methods and criteria for identifying suspected fraud cases, must have a method for verifying whether services billed were received, and must cooperate with the state's medicaid fraud control unit.
Acts 2006, ch. 1010, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2514 - Definitions

As used in §§
71-5-2513
- 71-5-2521, unless the context otherwise requires:
(1)
"Access" means the ability to extract intelligible information through automated means, and to store, retrieve, use, and otherwise manipulate that information in a way that may lead to meaningful analysis with the aid of commonly available computer software and hardware;
(2)
"Data" means representations of information, knowledge, facts, concepts, or instructions that are being prepared or have been prepared in a formalized manner, and are intended to be stored or processed, or are being stored or processed, or have been stored or processed in a computer, computer system, computer network or other electronic medium;
(3)
"Data mining" means the automated extraction of predictive information from data for the purpose of finding patterns of behavior and trends or anomalies that may otherwise escape detection, the advanced statistical analysis and modeling of the data to find useful patterns and relationships, and the use of computational techniques involving statistics, machine learning and pattern recognition to analyze the data;
(4)
"Single state agency" means the agency of the state of Tennessee that is designated, pursuant to
42 CFR 431.10(b)
, to administer or supervise the administration of the medicaid program under Title XIX of the Social Security Act (
42 U.S.C. § 1395
et seq.); and
(5)
"TennCare related data" means all data that relates to medical assistance or any assistance to TennCare recipients, applicants, or enrollees as defined in this part. The data includes data evidencing identity and eligibility of recipients and the receipt by recipients of medical assistance or any assistance paid for by TennCare.
Acts 2006, ch. 1010, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2515 - Data provided to the inspector general

All persons and entities under contract with the TennCare bureau or its agent or designee, including, but not limited to, all managed care organizations, benefit managers, and other managed care contractors, shall promptly provide to the office of inspector general, on request:
(1)
A copy of, or access to, the same data regularly provided to the bureau in the normal course of business, and in the same format, unless otherwise agreed by the inspector general in writing; and
(2)
Access to additional TennCare related data or records that may be requested by the inspector general; provided, that, if the data is not easily separated from non-TennCare related data, then all the data shall be provided as necessary to provide meaningful access to the TennCare related data.
Acts 2006, ch. 1010, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2516 - Confidentiality - Liability for providing data - Creation of new records or data - Destruction of data

(a)
All records obtained pursuant to this chapter shall be treated as confidential investigative records of the office of inspector general and shall not be open to public inspection; provided, however, that nothing in this part shall be construed to affect the obligation of the single state agency under federal law to provide the medicaid fraud control unit with access to, and free copies of, all records or information or computerized data kept or stored by the agency pursuant to
42 CFR 455.21(a)
.
(b)
Notwithstanding any other law to the contrary, no person shall be subject to any civil or criminal liability for providing the office of inspector general with access to data as required by this chapter.
(c)
Nothing in this chapter shall be construed to require any person or entity to create new records or data that did not exist at the time of the request; provided, that no person or entity may destroy existing data after having been put on notice that access to the data is required pursuant to this section.
Acts 2006, ch. 1010, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 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

(a)
The office of inspector general is authorized to require periodic provision of specific categories, types, or collations of data without the necessity of issuing a new request at the commencement of each period.
(b)
Compliance with a request by the office of inspector general is not dependent on approval by the bureau of TennCare, and it shall not be a defense to an action for enforcement or sanctions under this part that the bureau of TennCare does not require copies of or access to the requested data.
(c)
Data kept in the regular course of business in electronic format shall on request be provided to the office of inspector general in the same electronic format. The data shall be provided in a manner that permits meaningful analysis with the aid of commonly available computer software and hardware. To this end, access to data shall be accompanied by access to any existing record layout, field definitions, or other guides or directions associated with the data.
(d)
Notwithstanding any law to the contrary, access to data required pursuant to §§
71-5-2513
- 71-5-2521 shall be provided to the office of inspector general without charge.
(e)
The division of strategic technology solutions shall assist the office of inspector general by providing sufficient dedicated storage space and access to software on the state's computer network to permit the office of inspector general to accomplish the data mining contemplated by §§
71-5-2513
- 71-5-2521.
(f)
Nothing in this part shall be construed to prevent the bureau of TennCare or any other subdivision of the single state agency from conducting data mining, identifying suspected fraud cases, and referring suspected provider fraud to the medicaid fraud control unit pursuant to 42 CFR, Part 455 . Nothing in this part shall be construed to affect the obligation of the single state medicaid agency or any of its subdivisions to refer to the medicaid fraud control unit, pursuant to
42 CFR 455
, all cases in which the agency has reason to believe, after a preliminary investigation, that an incident of provider fraud or abuse has occurred in the TennCare program.
Amended by 2020 Tenn. Acts, ch. 690, s 21, eff. 6/11/2020.
Acts 2006, ch. 1010, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2518 - Rules and regulations

The inspector general shall have authority to promulgate rules and regulations pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, as are necessary to implement §§
71-5-2513
- 71-5-2521. The rules shall be promulgated as emergency rules. The inspector general is designated as the agency person to review initial orders and issue final agency orders pursuant to the Uniform Administrative Procedures Act.
Acts 2006, ch. 1010, § 1; 2009, ch. 566, § 12.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2519 - Written petition for objection to providing access to data - Enforcement of obligations

(a)
A person or entity requested to provide access to data pursuant to §§
71-5-2513
- 71-5-2521 may object to providing all or part of such access by filing a written petition with the inspector general within thirty (30) days of receipt of notice of the request to which objection is made. The petition shall be treated as a contested case pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(b)
(1)
In the event a person or entity requested to provide data pursuant to §§
71-5-2513
- 71-5-2521 fails to do so or to file a timely petition objecting to provision of the data, the office of inspector general has the authority to petition the chancery court of Davidson County through the attorney general and reporter, or by special appointment or delegation from the attorney general and reporter as provided by law, for enforcement of the obligations imposed by this chapter, and for recovery of costs, attorney's fees, and any applicable civil penalties.
(2)
Upon filing of a petition for enforcement by the inspector general, the court shall order the person or entity named in the petition to show cause why they should not be held in contempt for failure to comply with the request.
(3)
In ruling on the petition, the court shall be authorized to:
(A)
Order the person or entity, on pain of contempt, to comply with the request, and to punish each day of failure to comply with the order as a separate contempt of court; and
(B)
Award to the attorney general and reporter and, if applicable, the office of inspector general, reasonable costs and attorney's fees incurred in enforcing the requirement, if the state prevails.
(c)
(1)
Willful failure to provide data, or access to data, as required by this chapter, shall be subject to the same civil penalty established by law for willful failure to report recipient fraud to the inspector general.
(2)
A person or entity that has been assessed a civil penalty by the office of inspector general may object to the penalty by filing a written petition with the inspector general within thirty (30) days of receipt of notice of the assessment. The petition shall be treated as a contested case pursuant to the Uniform Administrative Procedures Act.
(3)
In the event that a person or entity that has been assessed a civil penalty by the office of inspector general has failed to pay the penalty or file a timely objection, the office of inspector general has the authority to file a petition in the chancery court of Davidson County through the attorney general and reporter, or by delegation from the attorney general and reporter as provided by law, for the collection of the penalty, and for enforcement of the request to provide access to data.
Acts 2006, ch. 1010, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2520 - Collections of penalties, fees and costs

(a)
All funds collected as civil penalties, attorney's fees, costs, or costs of investigation by the inspector general, pursuant to this part or part 26, shall be deposited by the state treasurer in a separate account exclusively for the use of that office to defray the expenses of continued operations involving recipient fraud and abuse, including, but not limited to, data mining, litigation, criminal investigation and prosecution, civil and administrative recovery, undercover operations involving recipient fraud, and training and equipment for employees; provided, that no part of the funds shall be used to supplement salaries of any public employee or law enforcement officer.
(b)
Funds collected pursuant to §§
71-5-2513
- 71-5-2521 may not supplant other state funds or appropriations. Any fund balance remaining unexpended at the end of a fiscal year in the account shall be carried forward into the subsequent fiscal year. No part of the fund shall be diverted to the general fund or any other public fund.
Acts 2006, ch. 1010, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 25 - TENNCARE FRAUD AND ABUSE (§§ 71-5-2501 — 71-5-2521) › Section 71-5-2521 - Report

The office of inspector general shall include in its annual report information on the progress of its data mining efforts, including any difficulties encountered in obtaining access to data from either private or government entities, and suggestions for legislative or other solutions.
Acts 2006, ch. 1010, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 26 - PREVENTION OF FRAUD AND ABUSE IN TENNCARE (§§ 71-5-2601 — 71-5-2604) › Section 71-5-2602 - Record keeping

(a)
Upon submitting a claim for, or upon receiving payment for, goods, services, items, facilities or accommodations under the TennCare program, a managed care organization, provider, vendor, subcontractor, or any other person or entity, shall maintain adequate records for a minimum of five (5) years after the date on which payment was received, if payment was received, or for five (5) years after the date on which the claim was submitted, if payment was not received. The bureau of TennCare shall have the authority to make appropriate and reasonable exceptions to the requirements of this subsection (a) upon a showing of good cause.
(b)
Failure to maintain adequate records is defined as negligently failing to maintain such records as are necessary to disclose fully the nature of the goods, services, items, facilities, or accommodations for which a claim was submitted or payment was received by the managed care organization, provider, vendor, subcontractor, or any other person or entity receiving funds originating from the TennCare program. Records include records kept in any form or fashion, including, but not limited to, any and all medical records, documents, data, or items, electronic or nonelectronic, related to the provision of and billing for services and goods. Failure to maintain adequate records during an audit period is punishable by recovery of one hundred fifty percent (150%) of the amount payable to the person or entity, directly or indirectly, using TennCare funds for the TennCare-related services for which the person or entity has failed to maintain records. Failure to maintain adequate records during a subsequent audit period is punishable by recovery of three hundred percent (300%) of the amount payable to the person or entity, directly or indirectly, using TennCare funds for the TennCare-related services for which the person or entity has failed to maintain records. Any further offense within five (5) years of the second offense may result in a recommendation by the office of inspector general to the bureau of TennCare to restrict the person or entity from receiving future TennCare payments. These matters shall be referred to the attorney general and reporter for recovery of funds.
Acts 2004, ch. 784, § 1; 2005, ch. 474, §§ 21, 22.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 5 - PROGRAMS AND SERVICES FOR POOR PERSONS (§§ 71-5-NEW — 71-5-2604) › Part 26 - PREVENTION OF FRAUD AND ABUSE IN TENNCARE (§§ 71-5-2601 — 71-5-2604) › Section 71-5-2603 - Fraud reporting requirements - Immunity from liability

(a)
All managed care organizations, contractors, subcontractors, providers or any other person or entity shall advise the office of TennCare inspector general immediately when there is actual knowledge, not subject to a testimonial privilege, that an act of recipient, enrollee, or applicant fraud is being, or has been committed. The office of TennCare inspector general shall review the information to determine if there is a sufficient basis to warrant a full investigation. The office of TennCare inspector general is authorized to establish an electronic system for treating physicians to report recipient, enrollee or applicant fraud.
(b)
All managed care organizations, contractors, subcontractors, providers or any other person or entity shall advise the medicaid fraud control unit (MFCU) immediately when there is actual knowledge, not subject to a testimonial privilege, that an act of provider fraud is being, or has been committed. The MFCU shall review the information to determine if there is a sufficient basis to warrant a full investigation. MFCU is authorized to establish an electronic system for treating physicians to report provider fraud.
(c)
Any person or entity making a complaint or furnishing a report, information or records in good faith pursuant to this section is immune from civil liability for making such complaint or report.
(d)
Willful failure to report such fraud shall be subject to a civil penalty of not more than ten thousand dollars ($10,000) for each finding to be assessed by the office of TennCare inspector general.
Acts 2004, ch. 784, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-101 - Short title - Legislative intent

(a)
This part may be cited as the "Tennessee Adult Protection Act."
(b)
(1)
The purpose of this part is to protect adults coming within this part from abuse, neglect or exploitation by requiring reporting of suspected cases by any person having cause to believe that such cases exist. It is intended that, as a result of such reports, the protective services of the state shall prevent further abuse, neglect or exploitation within the limitations set out in this part.
(2)
It is recognized that adequate protection of adults will require the cooperation of many agencies and service providers in conjunction with the department of human services due to the often complex nature of the risks to this adult group, and that services to meet the needs of this group will not always be available in each community. However, it is desirable that the following services, as well as other services needed to meet the intent of this part, be available: medical care, mental health and developmental disabilities services, including in-home assessments and evaluations; in-home services including homemaker, home-health, chore, meals; emergency services including shelter; financial assistance; legal services; transportation; counseling; foster care; day care; respite care; and other services as needed to carry out the intent of this part.
Acts 1978, ch. 899, § 1; T.C.A., § 14-2601; Acts 1986, ch. 630, § 1; T.C.A., § 14-25-101.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-104 - Remedies - Injunctive relief

(a)
Any court with jurisdiction under this part may upon proper application by the department issue a temporary restraining order or other injunctive relief to prohibit any violation of this part, regardless of the existence of any other remedy at law.
(b)
The court may enjoin from providing care for any person, on a temporary or permanent basis, any employee or volunteer, who the court finds has engaged in the abuse, neglect or exploitation of an adult as defined in this part, in any situation involving the care of such adult by such employee or volunteer, whether such actions occurred in an institutional setting, in any type of group home or foster care arrangement serving adults, and regardless of whether such person, facility or arrangement serving adults is licensed to provide care for adults.
Acts 1978, ch. 899, § 1; T.C.A., § 14-2604; Acts 1986, ch. 630, § 18; T.C.A., § 14-25-104; Acts 1995, ch. 486, § 8.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-105 - Reporting or investigating parties - Immunity from liability - Protection from job discrimination

Any person making any report or investigation pursuant to this part, including representatives of the department in the reasonable performance of their duties and within the scope of their authority, shall be presumed to be acting in good faith and shall thereby be immune from any liability, civil or criminal, that might otherwise be incurred or imposed. Any such participant shall have the same immunity with respect to participation in any judicial proceeding resulting from such report or investigation. Any person making a report under this part shall have a civil cause of action for appropriate compensatory and punitive damages against any person who causes a detrimental change in the employment status of the reporting party by reason of the report.
Acts 1978, ch. 899, § 1; T.C.A., § 14-2605; Acts 1980, ch. 513, § 6; T.C.A., § 14-25-105.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-106 - Privilege for confidential communications

Notwithstanding the existence of the privilege for confidential communications between husband and wife, the chancellor at the hearing may compel testimony if, in the chancellor's opinion, disclosure is necessary in the interest of the adult.
Acts 1978, ch. 899, § 1; T.C.A., §§ 14-2606, 14-25-106.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-108 - Prohibitions

No adult may be adjudicated incompetent or committed to a mental institution under this part.
Acts 1978, ch. 899, § 1; T.C.A., §§ 14-2608, 14-25-108.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-109 - Payment for protective services

If the department determines that the adult is financially capable of paying for the protective services received, according to standards to be set by the department, the adult shall reimburse the state for the cost of providing the protective services. If the department determines that the adult is not financially capable of paying for the protective services received, the state shall bear the cost of providing the protective services. Otherwise, the department may recover such cost from the adult in any court of competent jurisdiction.
Acts 1978, ch. 899, § 1; T.C.A., §§ 14-2609, 14-25-109.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-110 - Violation of duty to report

Any person who fails to make reasonable efforts to make a report required by this chapter or §
39-15-509(a)
commits a Class A misdemeanor.
Amended by 2018 Tenn. Acts, ch. 1050,s 16, eff. 1/1/2019.
Acts 1978, ch. 899, § 1; T.C.A., § 14-2610; Acts 1986, ch. 630, § 15; T.C.A., § 14-25-110; Acts 1989, ch. 591, § 111.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-111 - Authority and responsibility of department

It is the legislative intent that the protective services set out in this part be provided and that the department have present authority to provide or to arrange for the provision of the same. However, the provision of the services is subject to budgetary limitations and the availability of funds appropriated for the general provision of protective services to all persons entitled to services.
Acts 1978, ch. 899, § 1; T.C.A., §§ 14-2611, 14-25-111.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-112 - Funding

The cost of the administration of this part and the provision of the services hereby authorized shall be limited to the amount of funds specifically appropriated for such purposes by the general assembly.
Acts 1978, ch. 899, § 1; T.C.A., §§ 14-2612, 14-25-112.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-113 - Cooperation by other departments - Specialized care

(a)
It is the legislative intent that the departments of mental health and substance abuse services, disability and aging, and health, or their successor agencies, shall assist the department of human services with providing the services required under this part.
(b)
When the department of human services is unable to find a resource for any person in need of protective services who, because of mental or physical illness, intellectual disability or developmental disabilities, is in need of specialized care or medical treatment, the departments of mental health and substance abuse services, disability and aging, and health, or their successor agencies, shall, based upon available resources, give priority to the person for appropriate placement or treatment if the person is eligible for placement.
Amended by 2024 Tenn. Acts, ch. 688,s 190, eff. 7/1/2024.
Acts 1978, ch. 899, § 2; T.C.A., § 14-2613; Acts 1986, ch. 630, § 16; T.C.A., § 14-25-113; Acts 2000, ch. 947, § 6; 2009 , ch. 212, § 3; 2010 , ch. 1100, §§ 144, 145; 2011 , ch. 158, § 41; 2012 , ch. 575, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-114 - Jurisdiction and venue

(a)
The circuit, general sessions, and chancery courts have jurisdiction of proceedings arising under this part. Probate courts in counties having a population of not less than seven hundred seventy-five thousand (775,000) according to the 1980 federal census or any subsequent federal census shall have concurrent jurisdiction with the circuit and chancery courts.
(b)
A proceeding under this part may be commenced in the county where the adult resides or is physically present.
Acts 1986, ch. 630, § 4; T.C.A., § 14-25-114; Acts 1995, ch. 486, § 16.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-115 - Cooperation by law enforcement officials

It is the legislative intent that law enforcement officials shall cooperate with the department of human services in providing protective services under this part. Further, when the department is unable to return an adult to physical custody who voluntarily leaves such custody, law enforcement officials shall assist in returning the adult to such physical custody and shall give priority in providing such assistance.
Acts 1986, ch. 630, § 17; T.C.A., § 14-25-115.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-116 - Motion for review of court decree

Either party to a proceeding under this part, or any interested person on behalf of the adult subject to such a proceeding, may file a motion for review of the decree of the court at any time.
Acts 1986, ch. 630, § 17; T.C.A., § 14-25-116.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-117 - Abused or neglected person defined - Conflict with living will

(a)
For purposes of this part, a person is not abused or neglected or in need of protective services if the person subject to care intentionally and willfully chooses or consents to engage in a religious method of healing in accordance with a recognized religious belief in lieu of medical treatment.
(b)
This part does not require or authorize the provision of medical care to a terminally ill person if the person has executed an unrevoked living will in accordance with the Tennessee Right to Natural Death Act, compiled in title 32, chapter 11, and the provision of medical care would conflict with the terms of the living will.
Added by 2023 Tenn. Acts, ch. 277, s 4, eff. 4/28/2023.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-119 - [Repealed]

Repealed by 2019 Tenn. Acts, ch. 474, s 16, eff. 1/1/2020.
Amended by 2018 Tenn. Acts, ch. 1050, s 14, eff. 1/1/2019.
Acts 1995, ch. 486, § 6; 2007 , ch. 468, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-122 - Toll-free number for reporting elder abuse, neglect or exploitation

The division of adult protective services of the department of human services shall establish a toll-free telephone service to enable citizens within the state to call the division free of charge to report abuse, neglect, or exploitation and to seek relevant assistance from the division in such matters.
Acts 2004, ch. 780, § 7.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-123 - Reporting false accusations - Penalties - Investigation

(a)
It is an offense for a person to report to the department an accusation of abuse, sexual abuse, neglect or exploitation of an adult if, at the time of the report, the person knows or should know the accusation is false.
(b)
It is an offense for a person to knowingly cause another to report to the department an accusation of abuse, sexual abuse, neglect or exploitation of an adult if, at the time of the conduct, the person knows or should know the accusation is false.
(c)
A violation of this section is a Class A misdemeanor.
(d)
Notwithstanding §
71-6-118
to the contrary:
(1)
The department may report to the district attorney general or law enforcement authorities the identity of any person whom it reasonably believes has violated this section; and
(2)
The information such person reported or caused to be reported may be disclosed and utilized in any manner necessary by the department, the district attorney general or law enforcement authorities as part of any investigation or prosecution of a violation of this section.
Acts 2008, ch. 1005, § 1.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 1 - ADULT PROTECTION (§§ 71-6-101 — 71-6-126) › Section 71-6-126 - [Repealed]

Amended by 2021 Tenn. Acts, ch. 464, s 1, eff. 5/18/2021.
Added by 2019 Tenn. Acts, ch. 135, s 1, eff. 4/9/2019.
2023 Tennessee Code › Title 71 - WELFARE (§§ 71-1-101 — 71-7-103) › Chapter 6 - PROGRAMS AND SERVICES FOR ABUSED PERSONS (§§ 71-6-101 — 71-6-307) › Part 2 - FAMILY VIOLENCE SHELTERS AND CHILD ABUSE PREVENTION SERVICES (§§ 71-6-201 — 71-6-208) › Section 71-6-201 - Programs established - Funding

(a)
There are hereby established programs for the establishment and funding of family violence shelters and shelter services and child abuse prevention services. The program for the establishment of family violence shelters and shelter services shall be administered by the department of finance and administration. The program for the establishment of child abuse prevention services shall be administered by the department of children's services. Any reference to the department of human services in any existing statute, regulation, executive order, or contract relating to the administration of these programs shall be deemed to be a reference to the department that has jurisdiction over these programs pursuant to this section. This section does not change the agencies designated to receive certain reports under §
71-6-204
.
(b)
Funding for such programs shall be limited to the amounts provided in the general appropriations act.
Acts 1984, ch. 930, § 1; T.C.A., § 14-33-101; Acts 2002, ch. 697, § 1.