Section 0620-04-01-.02 - ELIGIBILITY(1) General rule. The Office of the Inspector General shall pay a monetary reward for information that leads to the arrest and conviction of any person or entity that has engaged in TennCare fraud. The determination of whether any person or entity meets the criteria for an award, and the amount of that award, is at the sole discretion of the Office of Inspector General (OIG). The OIG shall pay a reward only if a reward is not otherwise provided for by law. When the OIG applies the criteria specified under these rules to determine the eligibility and the amount of the reward, the OIG shall notify the beneficiary of the reward as specified below in 0620-4-1-.03.(2) A person or entity desiring consideration for a reward shall contact the Office of Inspector General through the TennCare Fraud and Abuse Hotline at 1-800-433-3982. Only information submitted by telephone is eligible for a reward.(3) Eligibility requirements. In order for a reporting person or entity to be eligible to receive a reward, the person or entity must: (a) Provide the following identifying information:4. Email address if available;(b) Provide information relating to the activities of a specified person or entity who at the time the information is provided is not already the subject of a review or investigation by the OIG or any of its contractors; the Tennessee Department of Human Services (DHS), the TennCare Bureau, the Tennessee Bureau of Investigation, the Office of the Inspector General for the U.S. Department of Health and Human Services or their contractors, the U.S. Department of Justice, or the Federal Bureau of Investigation;(c) State with specificity the time frame, and how the acts or omissions of the person or entity defrauded the TennCare program; and(d) Provide information that results in a criminal conviction.(4) Notwithstanding any other provisions of these rules, the following persons are excluded from eligibility to receive a reward: (a) Any person who is, or was at the time of acquiring the information or making the report, an officer or an employee of any of the agencies or entities listed above in (3)(b) at the time he or she came into possession of, or divulged information leading to a conviction;(b) Any person who is, or was at the time of acquiring the information or making the report, an immediate family member of an officer or an employee of any of the agencies or entities listed above in (3)(b) at the time he or she came into possession of, or divulged information leading to a conviction;(c) Any other Federal, State, County, or Municipal employee, contractor, or grantee, if the information submitted came to their knowledge in the normal course of their official duties;(d) A person or entity that illegally obtained the information submitted; or,(e) A person or entity that participated in, benefited from, or acquiesced in the criminal conduct which resulted in a criminal conviction.Tenn. Comp. R. & Regs. 0620-04-01-.02
Original rule filed July 26, 2006; effective November 26, 2006.Authority: T.C.A. §§ 4-5-202;71-5-2504 and 71-5-2512.