Program Integrity

A provider fraud task force was created to more effectively combat heath care fraud in the State of Tennessee. To find out more about this task force, please visit the Attorney General's website.

Under the Tennessee False Claims Act, those who knowingly submit, or cause another person or entity to submit, false claims for payment of government funds are liable for three times the government's damages plus civil penalties of $5,500 to $25,000 per false claim. TennCare's policy related to fraud and the False Claims Act PDF icon to symbol the link is a pdf.

Do you want to self-report an improper payment?

Providers shall perform self-audit and report overpayment and, when it is applicable, return overpayment to TennCare within 60 days from the date the overpayment is identified. Overpayments that are not returned within 60 days from the date the overpayment was identified can trigger a liability under the False Claims Act.

  1. Information on how to report or refund an improper payment PDF icon to symbol the link is a pdf.
  2. Provider appeal resources PDF icon to symbol the link is a pdf.
Report Fraud Hotlines

TennCare's Program Integrity Unit

U.S. Department of HHS OIG

Tennessee Bureau of Investigation

Tennessee's OIG

CMS Medicaid Integrity Group (MIG)

Resources

RAC FAQ PDF icon to symbol the link is a pdf

Recovery Audit Contractor (RAC) Information PDF icon to symbol the link is a pdf

OIG Provider Compliance Training at oig.hhs.gov