(2) Federal Mandatory Exclusion. The Bureau is required by federal law to exclude a provider from participation in the TennCare program upon notice from HHS or CMS under the following circumstances:

1. (a) Conviction of program-related crimes;
2. (b) Conviction relating to patient abuse;
3. (c) Felony conviction relating to health care fraud; or
4. (d) Felony conviction relating to controlled substance.

(3) Federal Permissive Exclusion. Pursuant to federal law, the Bureau may exclude a provider from participation in the TennCare program under the following circumstances:

1. (a) Conviction related to fraud;
2. (b) Conviction related to obstruction of an investigation or audit;
3. (c) Misdemeanor conviction related to controlled substance;
4. (d) License revocation or suspension;
5. (e) Exclusion or suspension under federal or state health care program;
6. (f) Claims for excessive charges or unnecessary services and failure of certain organizations to furnish medically necessary services;
7. (g) Fraud, kickbacks, and other prohibited activities;
8. (h) Entities controlled by a sanctioned individual;
9. (i) Failure to disclose required information;
10. (j) Failure to supply requested information on subcontractors and suppliers;
11. (k) Failure to supply payment information;
12. (l) Failure to grant immediate access;
13. (m) Failure to take corrective action;
14. (n) Default on health education loan or scholarship obligations;
15. (o) Individuals controlling a sanctioned entity; or
16. (p) Making false statements or misrepresentation of material facts.