Department of Finance & Administration
Mark Emkes, Commissioner

PIGEON FORGE WOMAN ADDS TO BUSIEST MONTH EVER FOR TENNCARE FRAUD UNIT

NASHVILLE –A Sevier County woman is indicted for TennCare fraud involving “doctor shopping,” or using TennCare to go to multiple doctors in a short time period to obtain controlled substances.  The arrest made for the busiest 30-day period for the unit responsible for looking for TennCare fraud among members of the healthcare insurance program.

The Office of Inspector General (OIG), with assistance from the Sevier County Sheriff, today announced the arrest of Cynthia D. Gornik, 37, of Pigeon Forge.  She is charged with five counts of fraudulently using TennCare to obtain controlled substances by “doctor shopping.” Gornik saw multiple physicians, obtaining prescriptions for painkillers, without disclosing to any doctor that she’d seen another physician and received a similar prescription.  Gornik received prescriptions for the painkillers Hydrocodone and Oxycodone, with the prescriptions being paid for by TennCare.

"We are delighted with the response we have received from physicians across the state in support of cracking down on people who try to doctor shop,” Inspector General Deborah Faulkner said. “The Special Agents of the OIG are out in force aggressively pursuing anyone who misusing the TennCare program.”

TennCare fraud involving doctor shopping is a Class E felony carrying a sentence of up to two years per charge in prison. District Attorney General James Dunn is prosecuting.

The OIG, which is separate from TennCare, began full operation in February 2005 and has investigated cases leading to over $2.5 million paid in restitution and recoupment to TennCare, with a total estimated cost avoidance of over $171 million for the TennCare program, according to latest figures.  To date, over 1,300 people have been charged with TennCare fraud.

Through the OIG Cash for Tips Program established by the Legislature, Tennesseans can get cash rewards for TennCare fraud tips that lead to convictions.  Anyone can report suspected TennCare fraud by calling 1-800-433-3982 toll-free from anywhere in Tennessee, or log on to www.tn.gov/tnoig and follow the prompts that read "Report TennCare Fraud."