Department of Finance & Administration
Mark Emkes, Commissioner

WILSON COUNTY WOMAN CHARGED WITH TENNCARE "DOCTOR SHOPPING"

 

NASHVILLE, TN - A Wilson County woman is charged with TennCare fraud involving “doctor shopping,” or using TennCare to go to multiple doctors in a short time period to obtain prescriptions for a controlled substance.

The Office of Inspector General (OIG) with the assistance of the Wilson County Sheriff’s Office today announced the arrest of Ashley Hester, 29, of Watertown.  She is accused of four counts of fraudulently using TennCare to obtain a controlled substance by “doctor shopping,” as well as four counts of obtaining a controlled substance by fraud.   Hester saw multiple physicians, without disclosing it, within a 30-day period, receiving prescriptions for the same or similar controlled substances with the physician office visits or the prescriptions being paid for by TennCare.

“Certain prescription drugs are classified as controlled substances because they have a dangerous potential for abuse and addiction,” Inspector General Deborah Faulkner said. “The TennCare program pays for such medications when prescribed under the direction and supervision of a physician, but we are committed to pursuing those cases involving fraud and abuse especially when dangerous drugs are involved.”

TennCare fraud is a Class E felony, carrying a sentence of up to two years in prison per charge.  Obtaining a controlled substance by fraud is a Class D felony, carrying a sentence of up to four years in prison per charge if convicted. District Attorney General Tom P. Thompson is prosecuting.

The OIG, which is separate from TennCare, began full operation in February 2005 and has investigated cases leading to over $3.5 million paid in restitution and recoupment to TennCare, with a total estimated cost avoidance of over $173 million for the TennCare program, according to latest figures.  To date, over 1,600 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."