Frequently Asked Questions

What statutory authority does the Office of Inspector General (OIG) have to perform its work?

See TCA 71-5-2505, TennCare Fraud and Abuse.

What exactly is FRAUD?

Fraud is an intentional deception or misrepresentation made by a person with knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable federal or state law. Also, see What is Fraud & Abuse.

Do you handle Food Stamp Fraud?

If the OIG receives a complaint that involves both TennCare fraud and Food Stamp fraud, we may conduct a joint investigation with the Department of Human Services.

How do I report Fraud in another State?

Call our office and let's determine if it is actually fraud in Tennessee or another state. If fraud is occurring in another state then we will provide a phone number for you.

Can you be on TennCare and have other insurance?

Yes. TennCare will be considered supplementary or secondary insurance.

Do you handle all fraud at this number?

The Office of Inspector General deals specifically with TennCare fraud.

With whom do I speak for Estate Recovery?

Call the office of General Counsel for TennCare 1-866-311-4287.

What is HIPAA?

Health Insurance Portability and Accountability Act, (HIPAA)

Can the OIG obtain private health information?

The Office of Inspector General is a healthcare oversight agency and may obtain protected health care information or PHI. Because the OIG requests information for health care oversight activities, 'minimum necessary' standards do not apply to those disclosures to the OIG. (see 45 C.F.R. §§164.501, 164.512(d), 165.502(b)(2)(v), and 162.52(d); Tenn.CodeAnn §71-5-2509.