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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 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.

Does the Office of Inspector General handle all TennCare fraud?

No, The Office of Inspector General deals specifically with TennCare recipient fraud.  The Tennessee Bureau of Investigation’s Medicaid Fraud Control Unit investigates TennCare provider fraud and patient abuse.  To report TennCare Provider fraud, call 1-800-433-5454 or e-mail tipstotbi@tn.gov.

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.

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.

How may I obtain a new TennCare card?

Call TennCare Solutions at 800-878-3192

Who do I call if I need to change my MCO, address or have questions about my TennCare benefits?

Call TennCare Solutions at 800-878-3192

My pharmacy won’t fill my prescriptions. Who can I contact to get this corrected?

Call TennCare Pharmacy at 888-816-1680

I suspect that there is an elderly person being abused, what do I do?

If you feel someone is in imminent (life-threatening) danger, contact your local law enforcement office or 911 immediately.  You may report suspected elder abuse to Adult Protective Services at 877-287-0010 or http://reportadultabuse.dhs.tn.gov.

How do I report suspected child abuse?

If you feel a child is in imminent (life-threatening) danger, contact your local law enforcement office or 911 immediately.  You may report suspected child abuse to the Department of Children’s Services at 877-237-0004 or report it online at https://apps.tn.gov/carat/.