Department of Finance & Administration
Mark Emkes, Commissioner

RECORD MONTH, RECORD YEAR FOR OFFICE OF INSPECTOR GENERAL

NASHVILLE, Tenn. – December was a record month and 2008 was a record year for the Office of Inspector General (OIG), the law enforcement agency tasked with pursuing fraud and criminal activity in TennCare and preserving the integrity of the expanded Medicaid program.

“We are very serious about our duty to eliminate fraud in TennCare and to see that justice is served for people committing these crimes,” Inspector General Deborah Y. Faulkner said.  “We pursue a lot of prescription drug fraud cases but we have also worked many cases where people try to hide their household income to get public-financed health care services.”

By the last week of December, the OIG had made 35 arrests for the month, including 20 who were arrested in Smith County on December 10 for prescription drug fraud involving pain medication obtained through TennCare with the intention to sell all or part of the prescription. 

Throughout 2008, the OIG also logged a record year with 262 arrests bringing to the total number of individuals arrested for TennCare fraud in four years to 867.  Faulkner said one of the most effective new tools the OIG special agents have is the “doctor shopping” law passed by the General Assembly and signed by the Governor in 2007.

“Once the ‘doctor shopping’ law was signed, we worked hard to get this information to pharmacists, medical providers and local police that this is now a crime that we can pursue,” Faulkner said.  “Those cases routinely involve painkillers, with the drugs of choice being Oxycontin, Oxycodone, Hydrocodone, Percocet and even Morphine.” 

Examples of OIG cases in 2008 include:

• A McNairy County woman pleaded guilty to TennCare fraud relating to a murder-for-hire plot.  She was charged with traveling to Dyersburg to hire an undercover agent who was posing as an assassin to kill her ex-husband.  She paid the agent $200 in cash and gave him 120 Hydrocodone pills which had been obtained through TennCare.
• In Macon County, a woman was charged with TennCare fraud and theft of services for obtaining medical services and not accurately reporting her own or her husband’s income, which would have made her ineligible for TennCare. She and her children received almost $35,000 in medical benefits they were not entitled to. 
• A woman from Knox County was charged with four counts of TennCare fraud and two counts of forgery when she attempted to use TennCare to fill forged prescriptions.
• A Bedford County woman pleaded guilty to five TennCare fraud charges after using TennCare to obtain prescriptions for the painkillers Morphine and Lortab, along with the anti-anxiety medication Xanax, while concealing that she planned to sell a portion of the pills.
• In Anderson County, a woman and man were each charged three times with TennCare fraud, with all the charges linked to obtaining controlled substances by committing fraud, forging prescriptions or identify theft.
• A Williamson County woman who was charged with doctor shopping to obtain the painkiller Hydrocodone was apparently living in Kentucky.  The OIG partnered with the U.S. Marshal to have her transported to the Williamson County jail to be charged.  She has since been charged a second time with doctor shopping.
• A Franklin County physician and a patient were each charged with criminal conspiracy in a scheme to defraud TennCare and fourteen counts of TennCare fraud.  The doctor was accused of writing prescriptions for the patient’s son, who was a TennCare member, for the Oxycodone and other drugs, including painkillers and anti-anxiety medications, with the son’s TennCare paying for the prescriptions.
• In Monroe County four people were charged with TennCare fraud in a round-up called “Operation RX” where 36 others were arrested on narcotics charges.

All the year’s TennCare fraud arrests and details of the crimes, along with photos, can be viewed online at http://tennessee.gov/finance/newsrel/newsroom.html#OIG.

The OIG, which is separate from TennCare, was created by Governor Bredesen and began full operation in February 2005 and has investigated cases leading to over $2.6 million paid in restitution and recoupment to TennCare, with a total estimated cost avoidance of over $159 million for the TennCare program, according to latest figures.

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.tncarefraud.tennessee.gov and follow the prompts that read "Report TennCare Fraud."