(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.

Terms Used In Tennessee Code 71-5-2517

  • Dependent: A person dependent for support upon another.
  • 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
  • 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
  • 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.
  • 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
  • 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
  • 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
  • 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
(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.
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