71-5-2604 - Administrative remedies Recovery of costs Contested cases Rules and regulations Final orders.
71-5-2604. Administrative remedies Recovery of costs Contested cases Rules and regulations Final orders.
(a) Without regard to any other civil or criminal liability that might attach, by operation of this section or any other law, the office of inspector general shall have an administrative remedy against an enrollee, recipient, applicant, or person purporting to be an enrollee, recipient, or applicant, who improperly obtains medical assistance benefits or any assistance from the TennCare program, to which the person is not entitled. The office of inspector general shall also have an administrative remedy against any person who assists any enrollee, recipient, or applicant, or purported enrollee, recipient, or applicant in improperly obtaining benefits or assistance.
(b) (1) The administrative remedy established by this section shall be for the recovery of the amount of:
(A) Any medical assistance benefits or any assistance improperly paid for by TennCare as a result of any misrepresentation or omission made by the person, to the extent that the amount has not otherwise been recovered by the TennCare bureau; and
(B) Any unpaid or underpaid premiums that were assessed at a lower monthly amount than would have been set if not for the misrepresentation or omission by the person, to the extent that the amount has not otherwise been recovered by the TennCare bureau.
(2) All such persons shall be jointly and severally liable to the state of Tennessee.
(c) The office of inspector general shall also have a right to recover the reasonable costs of proceedings pursuant to this section, including professional fees of court reporters and hearing officers or administrative judges, the reasonable costs of investigating claims arising under this section, reasonable attorney's fees, as well as interest on the amount owed by the person, calculated from the date that the medical assistance or any assistance was improperly received, or from the date the correct premiums should have been paid.
(d) All costs of medical assistance, or any assistance, or unpaid premiums recouped pursuant to this section, and any interest thereon, shall be paid to the TennCare bureau. All costs of proceedings, investigative costs, and attorney's fees pursuant to this section shall be paid to the office of inspector general, except as otherwise provided.
(e) Notwithstanding any other provision of law to the contrary, administrative actions pursuant to this section shall be commenced within four (4) years after the date of discovery by the state of the acts of misrepresentation or omission.
(f) The office of inspector general may invoke the remedy established by this section by initiating a contested case in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. In an administrative action under this subsection (f), the office of the inspector general shall show that the amount sought to be recovered was paid in the form of medical assistance benefits or any assistance as a result of material misrepresentation or omission. The office of inspector general need not show that the misrepresentation or omission was intentional or fraudulent.
(g) 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 the provisions of this part. The rules shall be promulgated as emergency rules. For purposes of rendering a final order pursuant to the Uniform Administrative Procedures Act, the inspector general is designated the agency person to review initial orders and issue final agency decisions. Orders issued by the inspector general shall have the effect of a final order pursuant to the Uniform Administrative Procedures Act.
(h) (1) Whenever an order issued by the inspector general pursuant to this part has become final, a notarized copy of the order may be filed in the office of the clerk of the chancery court of Davidson County.
(2) When filed in accordance with the provisions of this section, a final order shall be considered as a judgment by consent of the parties on the same terms and condition as those recited in the final order. The judgment shall be promptly entered by the court. Except as otherwise provided in this section, the procedure for entry of judgment and the effect of the judgment shall be the same as provided in title 26, chapter 6.
(3) A judgment entered pursuant to this section shall become final on the date of entry.
(4) A final judgment under this subsection (h) has the same effect, is subject to the same procedures, and may be enforced or satisfied in the same manner, as any other judgment of a court of record of this state.
[Acts 2006, ch. 1010, § 2; 2009, ch. 566, § 12.]