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TENNESSEE
FALSE CLAIMS ACT
(4-18-101 et
seq.)
AND
TENNESSEE
MEDICAID FALSE CLAIMS ACT
(71-5-181 et
seq.)
4-18-101. Short
title.
This act shall be known
and may be cited as the "False Claims Act".
4-18-102.
Definitions.
For purposes of this
Act:
(1) "Claim" includes
any request or demand for money, property, or services
made to any employee, officer, or agent of the state or
of any political subdivision, or to any contractor,
grantee, or other recipient, whether under contract or
not, if any portion of the money, property, or services
requested or demanded issued from, or was provided by,
the state (hereinafter "state funds") or by any
political subdivision thereof (hereinafter "political
subdivision funds"). (2) "Knowing" and "knowingly" mean
that a person, with respect to information, does any of
the following: (A) Has actual knowledge of the
information. (B) Acts in deliberate ignorance of the
truth or falsity of the information. (C) Acts in
reckless disregard of the truth or falsity of the
information. Proof of specific intent to defraud is not
required. (3) "Political subdivision" includes any city,
town, municipality, county, including any county having
a metropolitan form of government, or other legally
authorized local governmental entity with jurisdictional
boundaries. (4) "Prosecuting authority" refers to the
county counsel, city attorney, or other local government
official charged with investigating, filing, and
conducting civil legal proceedings on behalf of, or in
the name of, a particular political subdivision. (5)
"Person" includes any natural person, corporation, firm,
association, organization, partnership, limited
liability company, business, or trust.
4-18-103. Liability
for violations.
(a) Any person who
commits any of the following acts shall be liable to the
state or to the political subdivision for three (3)
times the amount of damages which the state or the
political subdivision sustains because of the act of
that person. A person who commits any of the following
acts shall also be liable to the state or to the
political subdivision for the costs of a civil action
brought to recover any of those penalties or damages,
and shall be liable to the state or political
subdivision for a civil penalty of not less than two
thousand five hundred dollars ($ 2,500) and not more
than ten thousand dollars ($ 10,000) for each false
claim:
(1) Knowingly presents
or causes to be presented to an officer or employee of
the state or of any political subdivision thereof, a
false claim for payment or approval;
(2) Knowingly makes,
uses, or causes to be made or used a false record or
statement to get a false claim paid or approved by the
state or by any political subdivision;
(3) Conspires to
defraud the state or any political subdivision by
getting a false claim allowed or paid by the state or by
any political subdivision;
(4) Has possession,
custody, or control of public property or money used or
to be used by the state or by any political subdivision
and knowingly delivers or causes to be delivered less
property than the amount for which the person receives a
certificate or receipt;
(5) Is authorized to
make or deliver a document certifying receipt of
property used or to be used by the state or by any
political subdivision and knowingly makes or delivers a
receipt that falsely represents the property used or to
be used;
(6) Knowingly buys, or
receives as a pledge of an obligation or debt, public
property from any person who lawfully may not sell or
pledge the property;
(7) Knowingly makes,
uses, or causes to be made or used a false record or
statement to conceal, avoid, or decrease an obligation
to pay or transmit money or property to the state or to
any political subdivision;
(8) Is a beneficiary of
an inadvertent submission of a false claim to the state
or a political subdivision, subsequently discovers the
falsity of the claim, and fails to disclose the false
claim to the state or the political subdivision within a
reasonable time after discovery of the false claim; or
(9) Knowingly makes,
uses, or causes to be made or used any false or
fraudulent conduct, representation, or practice in order
to procure anything of value directly or indirectly from
the state or any political subdivision.
(b) Notwithstanding
subsection (a), the court may assess not less than two
(2) times and nor more than three (3) times the amount
of damages which the state or the political subdivision
sustains because of the act of the person described in
that subsection, and no civil penalty, if the court
finds all of the following:
(1) The person
committing the violation furnished officials of the
state or of the political subdivision responsible for
investigating false claims violations with all
information known to that person about the violation
within thirty (30) days after the date on which the
person first obtained the information. (2) The person
fully cooperated with any investigation by the state or
a political subdivision of the violation. (3) At the
time the person furnished the state or the political
subdivision with information about the violation, no
criminal prosecution, civil action, or administrative
action had commenced with respect to the violation, and
the person did not have actual knowledge of the
existence of an investigation into the violation. (c)
Liability under this section shall be joint and several
for any act committed by two (2) or more persons. (d)
This section does not apply to any controversy involving
an amount of less than five hundred dollars ($ 500) in
value. For purposes of this subsection, "controversy"
means any one (1) or more false claims submitted by the
same person in violation of this article. (e) This
section does not apply to claims, records, or statements
made pursuant to workers' compensation claims. (f) This
section does not apply to claims, records, or statements
made under the Internal Revenue Code.
4-18-104.
Investigation and prosecution.
(a) (1) The attorney
general and reporter shall diligently investigate
violations under Section 3 of this Act involving state
funds. If the attorney general and reporter finds that a
person has violated or is violating Section 3 of this
Act, the attorney general and reporter may bring a civil
action under this section against that person. (2) If
the attorney general and reporter brings a civil action
under this subsection on a claim involving political
subdivision funds as well as state funds, the attorney
general and reporter shall, on the same date that the
complaint is filed in this action, serve by mail with
"return receipt requested" a copy of the complaint on
the appropriate prosecuting authority.
(3) The prosecuting
authority shall have the right to intervene in an action
brought by the attorney general and reporter under this
subsection within sixty (60) days after receipt of the
complaint pursuant to subdivision (2). The court may
permit intervention thereafter. (b) (1) The prosecuting
authority of a political subdivision shall diligently
investigate violations under Section 3 of this Act
involving political subdivision funds. If the
prosecuting authority finds that a person has violated
or is violating Section 3 of this Act, the prosecuting
authority may bring a civil action under this section
against that person. (2) If the prosecuting authority
brings a civil action under this section on a claim
involving state funds as well as political subdivision
funds, the prosecuting authority shall, on the same date
that the complaint is filed in this action, serve a copy
of the complaint on the attorney general and reporter.
(3) Within sixty (60)
days after receiving the complaint pursuant to
subdivision (2), the attorney general and reporter shall
do either of the following:
(A) Notify the court
that it intends to proceed with the action, in which
case the attorney general and reporter shall assume
primary responsibility for conducting the action and the
prosecuting authority shall have the right to continue
as a party; or
(B) Notify the court
that it declines to proceed with the action, in which
case the prosecuting authority shall have the right to
conduct the action. (c)
(1) A person may bring
a civil action for a violation of this Act for the
person and either for the state of Tennessee in the name
of the state, if any state funds are involved, or for a
political subdivision in the name of the political
subdivision, if political subdivision funds are
involved, or for both the state and political
subdivision if state and political subdivision funds are
involved. The person bringing the action shall be
referred to as the qui tam plaintiff. Once filed, the
action may be dismissed only with the written consent of
the court, taking into account the best interests of the
parties involved and the public purposes behind this
act. (2) A complaint filed by a private person under
this subsection shall be filed in circuit or chancery
court in camera and may remain under seal for up to
sixty (60) days. No service shall be made on the
defendant until after the complaint is unsealed. This
subsection shall not be construed as prohibiting an
action being brought in federal court that involves
claims from several states or claims involving federal
funds. (3) On the same day as the complaint is filed
pursuant to subdivision (2), the qui tam plaintiff shall
serve by mail with "return receipt requested" the
attorney general and reporter with a copy of the
complaint and a written disclosure of substantially all
material evidence and information the person possesses.
(4) Within sixty (60) days after receiving a complaint
and written disclosure of material evidence and
information alleging violations that involve state funds
but not political subdivision funds, the attorney
general and reporter may elect to intervene and proceed
with the action. (5) The attorney general and reporter
may, for good cause shown, move the court for extensions
of the time during which the complaint remains under
seal pursuant to subdivision (2). The motion may be
supported by affidavits or other submissions in camera.
(6) Before the expiration of the sixty (60) day period
or any extensions obtained under subdivision (5), the
attorney general and reporter shall do either of the
following:
(A) Notify the court
that it intends to proceed with the action, in which
case the action shall be conducted by the attorney
general and reporter and the seal shall be lifted; or
(B) Notify the court
that it declines to proceed with the action, in which
case the seal shall be lifted and the qui tam plaintiff
shall have the right to conduct the action. (7)
(A) Within fifteen (15)
days after receiving a complaint alleging violations
that exclusively involve political subdivision funds,
the attorney general and reporter shall forward copies
of the complaint and written disclosure of material
evidence and information to the appropriate prosecuting
authority for disposition, and shall notify the qui tam
plaintiff of the transfer. (B) Within forty-five (45)
days after the attorney general and reporter forwards
the complaint and written disclosure pursuant to subpart
(A), the prosecuting authority may elect to intervene
and proceed with the action. (C) The prosecuting
authority may, for good cause shown, move for extensions
of the time during which the complaint remains under
seal. The motion may be supported by affidavits or other
submissions in camera. (D) Before the expiration of the
forty-five (45) day period or any extensions obtained
under subpart (C), the prosecuting authority shall do
either of the following:
(i) Notify the court
that it intends to proceed with the action, in which
case the action shall be conducted by the prosecuting
authority and the seal shall be lifted; or
(ii) Notify the court
that it declines to proceed with the action, in which
case the seal shall be lifted and the qui tam plaintiff
shall have the right to conduct the action. (8)
(A) Within fifteen (15)
days after receiving a complaint alleging violations
that involve both state and political subdivision funds,
the attorney general and reporter shall forward copies
of the complaint and written disclosure to the
appropriate prosecuting authority, and shall coordinate
its review and investigation with those of the
prosecuting authority. (B) Within sixty (60) days after
receiving a complaint and written disclosure of material
evidence and information alleging violations that
involve both state and political subdivision funds, the
attorney general and reporter or the prosecuting
authority, or both, may elect to intervene and proceed
with the action. (C) The attorney general and reporter
or the prosecuting authority, or both, may, for good
cause shown, move the court for extensions of the time
during which the complaint remains under seal under
subdivision (2). The motion may be supported by
affidavits or other submissions in camera. (D) Before
the expiration of the sixty (60) day period or any
extensions obtained under subpart (C), the attorney
general and reporter shall do one of the following:
(i) Notify the court
that, it intends to proceed with the action, in which
case the action shall be conducted by the attorney
general and reporter and the seal shall be lifted;
(ii) Notify the court
that it declines to proceed with the action but that the
prosecuting authority of the political subdivision
involved intends to proceed with the action, in which
case the seal shall be lifted and the action shall be
conducted by the prosecuting authority; or
(iii) Notify the court
that both it and the prosecuting authority decline to
proceed with the action, in which case the seal shall be
lifted and the qui tam plaintiff shall have the right to
conduct the action. (E) If the attorney general and
reporter proceeds with the action pursuant to subitem
(D)(i) the prosecuting authority of the political
subdivision shall be permitted to intervene in the
action within sixty (60) days after the attorney general
and reporter notifies the court of its intentions. The
court may authorize intervention thereafter. (9) The
defendant shall not be required to respond to any
complaint filed under this section until thirty (30)
days after the complaint is unsealed and served upon the
defendant. (10) When a person brings an action under
this subsection, no other person may bring a related
action based on the facts underlying the pending action.
(d)
(1) No court shall have
jurisdiction over an action brought under subsection (c)
against a member of the general assembly, a member of
the state judiciary, an elected official in the
executive branch of the state, or a member of the
governing body of any political subdivision if the
action is based on evidence or information known to the
state or political subdivision when the action was
brought. (2) A person may not bring an action under
subsection (c) that is based upon allegations or
transactions that are the subject of a civil suit or an
administrative proceeding in which the state or
political subdivision is already a party. (3)
(A) No court shall have
jurisdiction over an action under this Act based upon
the public disclosure of allegations or transactions in
a criminal, civil, or administrative hearing, in an
investigation, report, hearing, or audit conducted by or
at the request of the general assembly, comptroller of
the treasury, or governing body of a political
subdivision, or by the news media, unless the action is
brought by the attorney general and reporter or the
prosecuting authority of a political subdivision or the
person bringing the action is an original source of the
information. (B) For purposes of subpart (A), "original
source" means an individual, who has direct and
independent knowledge of the information on which the
allegations are based, who voluntarily provided the
information to the state or political subdivision before
filing an action based on that information, and whose
information provided the basis or catalyst for the
investigation, hearing, audit, or report that led to the
public disclosure as described in subpart (A).
(4) No court shall have
jurisdiction over an action brought under subsection (c)
based upon information discovered by a present or former
employee of the state or a political subdivision during
the course of such person's employment unless that
employee first, in good faith, exhausted existing
internal procedures for reporting and seeking recovery
of the falsely claimed sums through official channels
and unless the state or political subdivision failed to
act on the information provided within a reasonable
period of time. (e) (1) If the state or political
subdivision proceeds with the action, it shall have the
primary responsibility for prosecuting the action. The
qui tam plaintiff shall have the right to continue as a
full party to the action. (2)
(A) The state or
political subdivision may seek to dismiss the action for
good cause notwithstanding the objections of the qui tam
plaintiff if the qui tam plaintiff has been notified by
the state or political subdivision of the filing of the
motion and the court has provided the qui tam plaintiff
with an opportunity to oppose the motion and present
evidence at a hearing. (B) The state or political
subdivision may settle the action with the defendant
notwithstanding the objections of the qui tam plaintiff
if the court determines, after a hearing providing the
qui tam plaintiff an opportunity to present evidence,
that the proposed settlement is fair, adequate, and
reasonable under all of the circumstances. (f) (1) If
the state or political subdivision elects not to
proceed, the qui tam plaintiff shall have the same right
to conduct the action as the attorney general and
reporter or prosecuting authority would have had if it
had chosen to proceed under subsection (c). If the state
or political subdivision so requests, and at its
expense, the state or political subdivision shall be
served with copies of all pleadings filed in the action
and supplied with copies of all deposition transcripts.
(2)
(A) Upon timely
application, the court shall permit the state or
political subdivision to intervene in an action with
which it had initially declined to proceed if the
interest of the state or political subdivision in
recovery of the property or funds involved is not being
adequately represented by the qui tam plaintiff. (B) If
the state or political subdivision is allowed to
intervene under subpart (A), the qui tam plaintiff shall
retain principal responsibility for the action and the
recovery of the parties shall be determined as if the
state or political subdivision had elected not to
proceed. (g)
(1)
(A) If the attorney
general and reporter initiates an action pursuant to
subsection (a) or assumes control of an action initiated
by a prosecuting authority pursuant to subsection
(b)(3)(A), the office of the attorney general and
reporter shall receive a fixed thirty-three percent
(33%) of the proceeds of the action or settlement of the
claim, which shall be used to support its ongoing
investigation and prosecution of false claims. (B) If a
prosecuting authority initiates and conducts an action
pursuant to subsection (b), the office of the
prosecuting authority shall receive a fixed thirty-three
percent (33%) of the proceeds of the action or
settlement of the claim, which shall be used to support
its ongoing investigation and prosecution of false
claims. (C) If a prosecuting authority intervenes in an
action initiated by the attorney general and reporter
pursuant to subdivision (a)(3) or remains a party to an
action assumed by the attorney general and reporter
pursuant to subsection (b)(3)(A), the court may award
the office of the prosecuting authority a portion of the
attorney general and reporter's fixed thirty-three
percent (33%) of the recovery under subpart (A), taking
into account the prosecuting authority's role in
investigating and conducting the action. (2) If the
state or political subdivision proceeds with an action
brought by a qui tam plaintiff under subsection (c), the
qui tam plaintiff shall, subject to subdivisions (4) and
(5), receive at least twenty-five percent (25%) but not
more than thirty-three percent (33%) of the proceeds of
the action or settlement of the claim, depending upon
the extent to which the qui tam plaintiff substantially
contributed to the prosecution of the action. When it
conducts the action, the attorney general and reporter's
office or the office of the prosecuting authority of the
political subdivision shall receive a fixed thirty-three
percent (33%) of the proceeds of the action or
settlement of the claim, which shall be used to support
its ongoing investigation and prosecution of false
claims made against the state or political subdivision.
When both the attorney general and reporter and a
prosecuting authority are involved in a qui tam action
pursuant to subsection
(c)(6)(C), the court at
its discretion may award the prosecuting authority a
portion of the attorney general and reporter's fixed
thirty-three percent (33%) of the recovery, taking into
account the prosecuting authority's contribution to
investigating and conducting the action. (3) If the
state or political subdivision does not proceed with an
action under subsection (c), the qui tam plaintiff
shall, subject to subdivisions (4) and (5), receive an
amount that the court decides is reasonable for
collecting the civil penalty and damages on behalf of
the government. The amount shall be not less than thirty
five percent (35%) and not more than fifty percent (50%)
of the proceeds of the action or settlement and shall be
paid out of these proceeds. (4) If the action is one
provided for under subsection (d)(4), the present or
former employee of the state or political subdivision is
not entitled to any minimum guaranteed recovery from the
proceeds. The court, however, may award the qui tam
plaintiff those sums from the proceeds as it considers
appropriate, but in no case more than thirty-three
percent (33%) of the proceeds if the state or political
subdivision goes forth with the action or fifty percent
(50%) if the state or political subdivision declines to
go forth, taking into account the significance of the
information, the role of the qui tam plaintiff in
advancing the case to litigation, and the scope of, and
response to, the employee's attempts to report and gain
recovery of the falsely claimed funds through official
channels. (5) If the action is one that the court finds
to be based primarily on information from a present or
former employee who actively participated in the
fraudulent activity, the employee is not entitled to any
minimum guaranteed recovery from the proceeds. The
court, however, may award the qui tam plaintiff any sums
from the proceeds it considers appropriate, but in no
case more than thirty-three percent (33%) of the
proceeds if the state or political subdivision goes
forth with the action or fifty percent (50%) if the
state or political subdivision declines to go forth,
taking into account the significance of the information,
the role of the qui tam plaintiff in advancing the case
to litigation, the scope of the present or past
employee's involvement in the fraudulent activity, the
employee's attempts to avoid or resist the activity, and
all other circumstances surrounding the activity. (6)
The portion of the recovery not distributed pursuant to
subdivisions (1) through (5), inclusive, shall revert to
the state if the underlying false claims involved state
funds exclusively and to the political subdivision if
the underlying false claims involved political
subdivision funds exclusively. If the violation involved
both state and political subdivision funds, the court
shall make an apportionment between the state and
political subdivision based on their relative share of
the funds falsely claimed. (7) For purposes of this
section, "proceeds" include civil penalties as well as
double or treble damages as provided in Section 3 of
this Act. (8) If the state, political subdivision, or
the qui tam plaintiff prevails in or settles any action
under subsection (c), the qui tam plaintiff shall
receive an amount for reasonable expenses that the court
finds to have been necessarily incurred, plus reasonable
costs and attorney's fees. All expenses, costs, and fees
shall be awarded against the defendant and under no
circumstances shall they be the responsibility of the
state or political subdivision. (9) If the state, a
political subdivision, or the qui tam plaintiff proceeds
with the action, the court may award to the defendant
its reasonable attorney's fees and expenses against the
party that proceeded with the action if the defendant
prevails in the action and the court finds that the
claim was clearly frivolous, clearly vexatious, or
brought solely for purposes of harassment. (h) The court
may stay an act of discovery of the person initiating
the action for a period of not more than sixty (60) days
if the attorney general and reporter or local
prosecuting authority shows that the act of discovery
would interfere with an investigation or a prosecution
of criminal or civil matter arising out of the same
facts, regardless of whether the attorney general and
reporter or local prosecuting authority proceeds with
the action. This showing shall be conducted in camera.
The court may extend the sixty (60) day period upon a
further showing in camera that the attorney general and
reporter or local prosecuting authority has pursued the
criminal or civil investigation or proceedings with
reasonable diligence and any proposed discovery in the
civil action will interfere with the ongoing criminal or
civil investigation or proceedings. (i) Upon a showing
by the attorney general and reporter or local
prosecuting authority that unrestricted participation
during the course of the litigation by the person
initiating the action would interfere with or unduly
delay the attorney general and reporter's or local
prosecuting authority's prosecution of the case, or
would be repetitious, irrelevant, or for purposes of
harassment, the court may, in its discretion, impose
limitations on the person's participation, including the
following:
(1) Limiting the number
of witnesses the person may call;
(2) Limiting the length
of the testimony of the witnesses;
(3) Limiting the
person's cross-examination of witnesses; or
(4) Otherwise limiting
the participation by the person in the litigation.
(j) There is hereby
created in the state treasury a fund to be known as "The
False Claims Act Fund". Proceeds from the action or
settlement of the claim by the attorney general and
reporter pursuant to this Act shall be deposited into
this fund. Moneys in this fund, upon appropriation by
the general assembly, shall be used by the attorney
general and reporter to support the ongoing
investigation and prosecution of false claims in
furtherance of this Act. Amounts in the fund at the end
of any fiscal year shall not revert to the general fund,
but shall remain available for the purposes set forth in
this Act.
4-18-105.
Prohibition against preventing employees from disclosing
information -
Violations -
Remedies.
(a) No employer shall
make, adopt, or enforce any rule, regulation, or policy
preventing an employee from disclosing information to a
government or law enforcement agency or from acting in
furtherance of a false claims action, including
investigating, initiating, testifying, or assisting in
an action filed or to be filed under Section 4 of this
Act. (b) No employer shall discharge, demote, suspend,
threaten, harass, deny promotion to, or in any other
manner discriminate against, an employee in the terms
and conditions of employment because of lawful acts done
by the employee on behalf of the employee or others in
disclosing information to a government or law
enforcement agency or in furthering a false claims
action, including investigation for, initiation of,
testimony for, or assistance in, an action filed or to
be filed under Section 4 of this Act. (c) An employer
who violates subsection (b) shall be liable for all
relief necessary to make the employee whole, including
reinstatement with the same seniority status that the
employee would have had but for the discrimination, two
(2) times the amount of back pay, interest on the back
pay, compensation for any special damage sustained as a
result of the discrimination, and, where appropriate,
punitive damages. In addition, the defendant shall be
required to pay litigation costs and reasonable
attorneys' fees. An employee may bring an action in the
appropriate chancery court of the state for the relief
provided in this subsection. (d) An employee who is
discharged, demoted, suspended, harassed, denied
promotion, or in any other manner discriminated against
in terms and conditions of employment by such person's
employer because of participation in conduct which
directly or indirectly resulted in a false claim being
submitted to the state or a political subdivision shall
be entitled to the remedies under subsection (c) if, and
only if, both of the following occur:
(1) The employee
voluntarily disclosed information to a government or law
enforcement agency or acted in furtherance of a false
claims action, including investigation for, initiation
of, testimony for, or assistance in an action filed or
to be filed; and
(2) The employee had
been harassed, threatened with termination or demotion,
or otherwise coerced by the employer or its management
into engaging in the fraudulent activity in the first
place.
4-18-106. Statute of
limitations.
(a) A civil action
under Section 4 of this Act may not be filed more than
three (3) years after the date of discovery by the
official of the state or political subdivision charged
with responsibility to act in the circumstances or, in
any event, no more than ten (10) years after the date on
which the violation of Section 3 of this Act is
committed. (b) A civil action under Section 4 of this
Act may be brought for activity prior to July 1, 2001,
if the limitations period set in subsection (a) has not
lapsed. (c) In any action brought under Section 4 of
this Act, the state, the political subdivision, or the
qui tam plaintiff shall be required to prove all
essential elements of the cause of action, including
damages, by a preponderance of the evidence. (d)
Notwithstanding any other provision of law to the
contrary, a guilty verdict rendered in a criminal
proceeding charging false statements or fraud, whether
upon a verdict after trial or upon a plea of guilty or
nolo contendere, except for a plea of nolo contendere
made prior to July 1, 2001, shall stop the defendant
from denying the essential elements of the offense in
any action which involves the same transaction as in the
criminal proceeding and which is brought under
subsection (a), (b), or (c) of Section 4 of this Act.
4-18-107. Provisions
are not exclusive - Liberal construction.
(a) The provisions of
this Act are not exclusive, and the remedies provided
for in this Act shall be in addition to any other
remedies provided for by law or available under common
law. (b) If any provision of this act or the application
thereof to any person or circumstance is held invalid,
such invalidity shall not affect other provisions or
applications of the act which can be given effect
without the invalid provision or application, and to
that end the provisions of this act are declared to be
severable. (c) The provisions of this act are declared
to be remedial in nature and the provisions of this act
shall be liberally construed to effectuate its purposes.
4-18-108.
Inapplicable to medical claims.
This act shall not
apply to any conduct, activity or claims covered by the
Medicaid False Claims Act, Tennessee Code Annotated,
Section 71-5-181 through Section 71-5-185, including
without limitation, claims arising out of funds paid to
or by TennCare managed care organizations. SECTION 9.
This act shall take effect July 1, 2001, the public
welfare requiring it. HISTORY: Approved
by the Governor June 7, 2001.
TENNESSEE MEDICAID FALSE CLAIMS ACT
71-5-181 Tennessee
Medicaid False Claims Act -- Short title.
(a) The title of this
section and §§ 71-5-182 -- 71-5-186 is and may be cited
as the "Tennessee Medicaid False Claims Act."
(b) "Medicaid program"
as used in §§ 71-5-182 -- 71-5-186 includes the TennCare
program and any successor program to the medicaid
program.
71-5-182 Violations
-- Damages -- Definitions.
(a)(1) Any person who:
(A) Presents, or causes
to be presented, to the state a claim for payment under
the Medicaid program knowing such claim is false or
fraudulent;
(B) Makes, uses, or
causes to be made or used, a record or statement to get
a false or fraudulent claim under the Medicaid program
paid for or approved by the state knowing such record or
statement is false;
(C) Conspires to
defraud the state by getting a claim allowed or paid
under the Medicaid program knowing such claim is false
or fraudulent; or
(D) Makes, uses, or
causes to be made or used, a record or statement to
conceal, avoid, or decrease an obligation to pay or
transmit money or property to the state, relative to the
Medicaid program, knowing such record or statement is
false;
is liable to the state
for a civil penalty of not less than five thousand
dollars ($5,000) and not more than ten thousand dollars
($10,000), plus three (3) times the amount of damages
which the state sustains because of the act of that
person.
(2) However, if the
court finds that:
(A) The person
committing the violation of this subsection furnished
officials of the state responsible for investigating
false claims violations with all information known to
such person about the violation within thirty (30) days
after the date on which the defendant first obtained the
information;
(B) Such person fully
cooperated with any state investigation of such
violation; and
(C) At the time such
person furnished the state with the information about
the violation, no criminal prosecution, civil action, or
administrative action had commenced under §§ 71-5-181 --
71-5-186 with respect to such violation, and the person
did not have actual knowledge of the existence of an
investigation into such violation;
the court may assess
not less than two (2) times the amount of damages which
the state sustains because of the act of the person. A
person violating this subsection shall also be liable
for the costs of a civil action brought to recover any
such penalty or damages.
(b) For purposes of
this section, "knowing" and "knowingly" mean that a
person, with respect to information:
(1) Has actual
knowledge of the information;
(2) Acts in deliberate
ignorance of the truth or falsity of the information; or
(3) Acts in reckless
disregard of the truth or falsity of the information,
and no proof of specific intent to defraud is required.
71-5-183 Civil
actions -- Employee remedies.
(a)(1) A person may
bring a civil action for a violation of § 71-5-182 for
the person and for the state. The action shall be
brought in the name of the state of Tennessee. The
action may be dismissed only if the court and the
attorney general and reporter or district attorney
general give written consent to the dismissal and their
reasons for consenting.
(2) A copy of the
complaint and written disclosure of substantially all
material evidence and information the person possesses
shall be served on the state. The complaint shall be
filed in camera, shall remain under seal for at least
sixty (60) days, and shall not be served on the
defendant until the court so orders. The state may elect
to intervene and proceed with the action within sixty
(60) days after it receives both the complaint and the
material evidence and information.
(3) The state may, for
good cause shown, move the court for extensions of the
time during which the complaint remains under seal under
subdivision (a)(2). Any such motions may be supported by
affidavits or other submissions in camera. The defendant
shall not be required to respond to any complaint filed
under this section until twenty (20) days after the
complaint is unsealed and served upon the defendant.
(4) Before the
expiration of the sixty 60-day period or any extensions
obtained under subdivision (a)(3), the state shall:
(A) Proceed with the
action, in which case the action shall be conducted by
the state; or
(B) Notify the court
that it declines to take over the action, in which case
the person bringing the action shall have the right to
conduct the action.
(5) When a person
brings an action under this subsection, no person other
than the state may intervene or bring a related action
based on the facts underlying the pending action.
(b)(1) If the state
proceeds with the action, it shall have the primary
responsibility for prosecuting the action, and shall not
be bound by an act of the person bringing the action.
Such person shall have the right to continue as a party
to the action, subject to the limitations set forth in
subdivision (b)(2).
(2)(A) The state may
dismiss the action notwithstanding the objections of the
person initiating the action if the person has been
notified by the state of the filing of the motion and
the court has provided the person with an opportunity
for a hearing on the motion.
(B) The state may
settle the action with the defendant notwithstanding the
objections of the person initiating the action if the
court determines, after a hearing, that the proposed
settlement is fair, adequate, and reasonable under all
the circumstances. Upon a showing of good cause, such
hearing may be held in camera.
(C) Upon a showing by
the state that unrestricted participation during the
course of the litigation by the person initiating the
action would interfere with or unduly delay the state's
prosecution of the case, or would be repetitious,
irrelevant, or for purposes of harassment, the court
may, in its discretion, impose limitations on the
person's participation such as:
(i) Limiting the number
of witnesses the person may call;
(ii) Limiting the
length of the testimony of such witnesses;
(iii) Limiting the
person's cross-examination of witnesses; or
(iv) Otherwise limiting
the participation by the person in the litigation.
(D) Upon a showing by
the defendant that unrestricted participation during the
course of the litigation by the person initiating the
action would be for purposes of harassment or would
cause the defendant undue burden or unnecessary expense,
the court may limit the participation by the person in
the litigation.
(3) If the state elects
not to proceed with the action, the person who initiated
the action shall have the right to conduct the action.
If the state so requests, it shall be served with copies
of all pleadings filed in the action and shall be
supplied with copies of all deposition transcripts (at
the state's expense). When a person proceeds with the
action, the court, without limiting the status and
rights of the person initiating the action, may
nevertheless permit the state to intervene at a later
date upon a showing of good cause.
(4) Whether or not the
state proceeds with the action, upon a showing by the
state that certain actions of discovery by the person
initiating the action would interfere with the state's
investigation or prosecution of a criminal or civil
matter arising out of the same facts, the court may stay
such discovery for a period of not more than sixty (60)
days. Such a showing shall be conducted in camera. The
court may extend the sixty-day period upon a further
showing in camera that the state has pursued the
criminal or civil investigation or proceedings with
reasonable diligence and any proposed discovery in the
civil action will interfere with the ongoing criminal or
civil investigation or proceedings.
(5) Notwithstanding
subsection (a), the state may elect to pursue its claim
through any alternate remedy available to the state,
including any administrative proceeding to determine a
civil monetary penalty. If any such alternate remedy is
pursued in another proceeding, the person initiating the
action shall have the same rights in such proceedings as
such person would have had if the action had continued
under this section. Any finding of fact or conclusion of
law made in such other proceeding that has become final
shall be conclusive on all parties to an action under
this section. For purposes of the preceding sentence, a
finding or conclusion is final if it has been finally
determined on appeal to the appropriate court of
jurisdiction, if all time for filing such an appeal with
respect to the finding or conclusion has expired, or if
the finding or conclusion is not subject to judicial
review.
(c)(1) If the state
proceeds with an action brought by a person under
subsection (a), a person shall, subject to the second
sentence of this paragraph, receive at least fifteen
percent (15% ) but not more than twenty- five percent
(25% ) of the proceeds of the action or settlement of
the claim, depending upon the extent to which the person
substantially contributed to the prosecution of the
action. Where the action is one which the court finds to
be based primarily on disclosures of specific
information (other than information provided by the
person bringing the action) relating to allegations or
transactions in a criminal, civil, or administrative
hearing, report, audit, investigation, or from the news
media, the court may award such sums as it considers
appropriate, but in no case more than ten percent (10% )
of the proceeds, taking into account the significance of
the information and the role of the person bringing the
action in advancing the case to litigation. Any payment
to a person under the first or second sentence of this
subdivision shall be made from the proceeds. Any such
person shall also receive an amount for reasonable
expenses which the court finds to have been necessarily
incurred, plus reasonable attorneys' fees and costs. All
such expenses, fees, and costs shall be awarded against
the defendant.
(2) If the state does
not proceed with an action under this section, the
person bringing the action or settling the claim shall
receive an amount which the court decides is reasonable
for collecting the civil penalty and damages. The amount
shall be not less than twenty-five percent (25% ) and
not more than thirty percent (30% ) of the proceeds of
the action or settlement and shall be paid out of such
proceeds. Such person shall also receive an amount for
reasonable expenses which the court finds to have been
necessarily incurred, plus reasonable attorneys' fees
and costs. All such expenses, fees, and costs shall be
awarded against the defendant.
(3) Whether or not the
state proceeds with the action, if the court finds that
the action was brought by a person who planned and
initiated the violation of § 71-5-182 upon which the
action was brought, then the court may, to the extent
the court considers appropriate, reduce the share of the
proceeds of the action which the person would otherwise
receive under subdivision (c)(1) or (2), taking into
account the role of that person in advancing the case to
litigation and any relevant circumstances pertaining to
the violation. If the person bringing the action is
convicted of criminal conduct arising from such person's
role in the violation of § 71-5-181, that person shall
be dismissed from the civil action and shall not receive
any share of the proceeds of the action. Such dismissal
shall not prejudice the right of the state to continue
the action.
(4) If the state does
not proceed with the action and the person bringing the
action conducts the action, the court shall award to the
defendant its reasonable attorneys' fees and expenses if
the defendant prevails in the action and the court finds
that the claim of the person bringing the action was
clearly frivolous, clearly vexatious, or brought
primarily for purposes of harassment.
(d)(1) In no event may
a person bring an action under subsection (a) which is
based upon allegations or transactions which are the
subject of a civil suit or an administrative civil
monetary penalty proceeding in which the state is
already a party.
(2)(A) No court shall
have jurisdiction over an action under this section
based upon the public disclosure of allegations or
transactions in a criminal, civil, or administrative
hearing, audit, investigation, or from the news media,
unless the action is brought by the attorney general and
reporter or district attorney general or the person
bringing the action is an original source of the
information.
(B) For purpose of this
subdivision (2), "original source" means an individual
who has direct and independent knowledge of the
information on which the allegations are based and who
has voluntarily provided the information to the state
before filing an action under this section which is
based on the information.
(e) The state is not
liable for expenses which a person incurs in bringing an
action under this section.
(f) Any employee who is
discharged, demoted, suspended, threatened, harassed, or
in any other manner discriminated against in the terms
and conditions of employment by such employee's employer
because of lawful acts done by the employee on behalf of
the employee or others in furtherance of an action under
this section, including investigation for, initiation
of, testimony for, or assistance in an action filed or
to be filed under this section, shall be entitled to all
relief necessary to make the employee whole. Such relief
shall include reinstatement with the same seniority
status such employee would have had but for the
discrimination, two (2) times the amount of back pay,
interest on the back pay, and compensation for any
special damages sustained as a result of the
discrimination, including litigation costs and
reasonable attorneys' fees. An employee may bring an
action in the appropriate court for the relief provided
in this subsection.
71-5-184 Service --
Limitations.
(a) A subpoena
requiring the attendance of a witness at a trial or
hearing conducted under § 71-5-183 may be served at any
place in the United States.
(b) A civil action
under § 71-5-183 may not be brought:
(1) More than six (6)
years after the date on which the violation of § 71-
5-182 is committed, or
(2) More than three (3)
years after the date when facts material to the right of
action are known or reasonably should have been known by
the official of the state charged with responsibility to
act in the circumstances, but in no event more than ten
(10) years after the date on which the violation is
committed, whichever occurs last.
(c) In any action
brought under § 71-5-183, the state shall be required to
prove all essential elements of the cause of action,
including damages, by a preponderance of the evidence.
(d) Notwithstanding any
other provision of law, the Rules of Criminal Procedure,
or the Rules of Evidence, a final judgment rendered in
favor of the state in any criminal proceeding charging
fraud or false statements, whether upon a verdict after
trial or upon a plea of guilty or nolo contendere, shall
stop the defendant from denying the essential elements
of the offense in any action which involves the same
transaction as in the criminal proceeding and which is
brought under subsection (a) or (b) or § 71-5-183.
71-5-185 Venue.
Any action under §
71-5-183 may be brought in any judicial district in
which the defendant or, in the case of multiple
defendants, any one (1) defendant can be found, resides,
transacts business, or in which any act proscribed by §
71-5-182 occurred. A summons as required by the Rules of
Civil Procedure shall be issued by the appropriate
district court and served at any place within or outside
the United States.
71-5-186 False
claims.
(a) It is an offense if
any person makes or presents to any person or department
or agency of the state, any claim upon or against the
state, or any department or agency thereof, knowing such
claim to be false, fictitious, or fraudulent.
(b) A violation of this
section is punishable as theft and graded pursuant to §
39-14-105. |