Tennessee Code Annotated
Tenn. Code Ann. § 71-5-118 (2026)
Contracts with vendors - Sanctions against vendors - Grounds for actions against providers - Administrative remedy to recover benefits from applicant - Collection activity report - Applicant warning - Prompt process of hospital presumptive eligibility applications
✓ current as of May 2026
- (a) The commissioner of finance and administration has the authority to enter into contracts with qualified vendors to provide to eligible recipients medical assistance allowed under § 71-5-107. The commissioner has the authority to terminate or suspend existing contracts with providers, to refuse to enter into contracts with providers, and to recover any payments incorrectly paid if the commissioner finds that such actions will further the purpose of this section. Any action against such provider shall be treated as a contested case in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. If a hearing is requested by the provider, it shall be held prior to the imposition of any of the sanctions of this subsection (a), except that upon a finding by the commissioner that the public health, safety, or welfare imperatively requires emergency action, these sanctions may be imposed pending an opportunity for the provider to request a prompt hearing. Furthermore, the commissioner has the right to set off any money incorrectly paid against any claim for money submitted by the provider pending an opportunity for a hearing. Grounds for action against providers under this subsection (a) include, but are not limited to, the following:
- (1) Violation of the terms of the contract;
- (2) Violation of any provision of this part or the rules promulgated pursuant to this part;
- (3) Billing for medical assistance that was not delivered;
- (4) Provision of medical assistance that is not medically necessary or justified;
- (5) Provision of medical assistance of a quality that is below professionally recognized standards;
- (6) Revocation or suspension of a provider's professional license or other disciplinary action by the agency regulating the profession of the provider; and
- (7) Failure to produce records, upon request, by authorized representatives of the commissioner as necessary to substantiate the medical assistance for which claims have been submitted.
- (b) Without regard to any other civil or criminal liability that might attach, by operation of this section or any other law, to an enrollee or applicant's action in obtaining medical assistance or any assistance under this part, to which such person is not entitled, the bureau of TennCare shall have an administrative remedy for the recovery of the amount of any medical assistance benefits or payments improperly paid as a result of any misrepresentation made by such person, to the extent that such amount has not otherwise been recovered by the bureau. The bureau shall also have a right to recover in such administrative proceedings its reasonable costs and attorneys' fees, as well as interest on the amount owed by the person, calculated from the date that medical assistance was improperly paid. Any action against such person shall be treated as a contested case in accordance with the Uniform Administrative Procedures Act. In an administrative action under this subsection (b), the bureau shall show that the amount sought to be recovered was paid in the form of medical assistance as a result of material misrepresentation by the person against whom recovery is sought, but the bureau need not show that such misrepresentation was intentional or fraudulent.
- (c) The bureau of TennCare shall report annually in writing to the judiciary committee of the senate and the criminal justice committee of the house of representatives regarding its collection activities of the estate recovery provisions of this chapter.
- (d) All applicants for medical assistance under this part, and all applicants for reverification of eligibility to receive such assistance, shall receive a warning, in easily readable language, regarding the state recovery provisions, as well as the administrative, civil and criminal liability provisions of this chapter.
- (e) The participating provider shall strive to process hospital presumptive eligibility applications within the first twenty-four (24) hours of the date of admission, when practicable. To the extent a participating provider fails to adhere to this standard, the bureau of TennCare may take remedial steps as allowed by federal law.
Amended by 2021 Tenn. Acts, ch. 64, s 122, eff. 3/29/2021.
Amended by 2020 Tenn. Acts, ch. 775, s 1, eff. 7/15/2020.
Amended by 2019 Tenn. Acts, ch. 345, s 136, eff. 5/10/2019.
Amended by 2013 Tenn. Acts, ch. 236, s 43, eff. 4/19/2013.
Acts 1968, ch. 551, § 18; 1973, ch. 73, § 2; 1978, ch. 539, § 1; T.C.A., § 14-1918; Acts 1982, ch. 730, § 16; T.C.A., § 14-23-118; Acts 1987, ch. 420, § 1; 1989, ch. 591, § 107; 1991, ch. 406, § 2; 1993, ch. 428, § 1; 2000, ch. 853, § 1; 2002, ch. 702, § 1; 2002, ch. 880, §§ 7, 10 - 13; 2004, ch. 673, § 10.
Notes of Decisions
Cited in 7
cases, 1993–2015 · leading case: In Re Conservatorship of Groves, 109 S.W.3d 317 (Tenn. Ct. App. 2003).
In Re Conservatorship of Groves, 109 S.W.3d 317 (Tenn. Ct. App. 2003). “In addition, if the benefits were paid as a result of the recipient’s misrepresentation, Tenn.Code Ann. § 71-5-118® authorized the Bureau of TennCare to initiate a contested case proceeding against the recipient to recover the “improperly” paid benefits, as well as attorney’s…”
State v. Carr, 861 S.W.2d 850 (Tenn. Crim. App. 1993). “e counts for offenses which involved Medicaid payments and were alleged as follows: *853 (1) First Count — Between October 21, 1987, and October 31, 1989, by means of a fraudulent scheme or device, the defendants unlawfully, feloniously, and willfully obtained or attempted to…”
Snodgrass-King Pediatric Dental Assocs., P.C. v. DentaQuest USA Ins., 79 F. Supp. 3d 753 (M.D. Tenn. 2015). “§' 1396u-2, prohibits discrimination against providers that serve high risk populations and creates an enforceable property interest; (4) that, for their due process claims, both Plaintiffs’ prior longstanding participation as a dental provider and Tenn.Code Ann. § 71-5-118’s…”
Clay Cty. Manor v. State, D. of Health, 849 S.W.2d 755 (Tenn. 1993). “See T.C.A. § 71-5-118(a). Consequently, it receives substantial state and federal funds for the care of eligible patients and is subject to federal and state inspections to monitor compliance with Medicaid standards of care.”
Publix Super Markets, Inc. v. Tennessee Dep't of Labor & Workforce Dev., Labor Standards Div., 402 S.W.3d 218 (Tenn. Ct. App. 2012). “In that opinion, the Attorney General opined on the question of whether a demand by an agent of the Tennessee Bureau of Investigation made pursuant to Tennessee Code Annotated § 71-5-118 and Executive Order 87 that a physician participating in the Medicaid program produce…”
In re: Est. of Roy W. Barnett (Tenn. Ct. App. 2005). “” Tenn. Code Ann. § 71-5-118 (l) (2003). Initially, the Bureau argues that the notice requirement of section 71-5-118(l) of the Tennessee Code should not apply in this case to correctly paid benefits since the remainder of that section concerns fraud, abuse, and incorrectly paid…”
George Haskel Stewart v. Demple L. Sewell (Tenn. Ct. App. 2005). “§ 1396p(c)(1)(B)(i) Any person who fails to disclose transfers of assets for less than fair market value occurring after the "look back" date is subject to losing benefits for a defined period, and may be subject to criminal prosecution if the failure to disclose the transfer is…”
— Tenn. Code Ann. § 71-5-118(a) — 1 case
Clay Cty. Manor v. State, D. of Health, 849 S.W.2d 755 (Tenn. 1993). “See T.C.A. § 71-5-118(a). Consequently, it receives substantial state and federal funds for the care of eligible patients and is subject to federal and state inspections to monitor compliance with Medicaid standards of care.”
— Tenn. Code Ann. § 71-5-118(b)(1)(A) — 1 case
In Re Conservatorship of Groves, 109 S.W.3d 317 (Tenn. Ct. App. 2003). “In addition, if the benefits were paid as a result of the recipient’s misrepresentation, Tenn.Code Ann. § 71-5-118® authorized the Bureau of TennCare to initiate a contested case proceeding against the recipient to recover the “improperly” paid benefits, as well as attorney’s…”
— Tenn. Code Ann. § 71-5-118(i) — 1 case
In Re Conservatorship of Groves, 109 S.W.3d 317 (Tenn. Ct. App. 2003). “In addition, if the benefits were paid as a result of the recipient’s misrepresentation, Tenn.Code Ann. § 71-5-118® authorized the Bureau of TennCare to initiate a contested case proceeding against the recipient to recover the “improperly” paid benefits, as well as attorney’s…”
— Tenn. Code Ann. § 71-5-118(l) — 1 case
In re: Est. of Roy W. Barnett (Tenn. Ct. App. 2005). “” Tenn. Code Ann. § 71-5-118 (l) (2003). Initially, the Bureau argues that the notice requirement of section 71-5-118(l) of the Tennessee Code should not apply in this case to correctly paid benefits since the remainder of that section concerns fraud, abuse, and incorrectly paid…”
Annotations are extracted automatically from the opinions in the
Syfert caselaw corpus and ranked by authority, recency, and
treatment. Dots show Syfertize treatment of the citing case itself.