Department of Finance & Administration
Mark Emkes, Commissioner

HAMILTON COUNTY WOMAN INDICTED FOR TENNCARE FRAUD

NASHVILLE, Tenn. - A Hamilton County woman has been indicted for 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 Hamilton County Sheriff's Office today announced the arrest of Tracy N. Carter, 21, of Chattanooga. She is charged with two counts of fraudulently using TennCare to obtain a controlled substance by " doctor shopping."

TCarter failed to disclose to her doctor that she had seen other physicians within a 30-day period and received prescriptions for the strong painkillers hydrocodone and oxycodone, with the physician office visits and prescriptions being paid for by TennCare.

"The "doctor shopping" law enacted a couple of years ago allowed us to start going after cases where people were abusing TennCare in order to obtain prescriptions for drugs," Inspector General Deborah Faulkner said. " Physicians really had no where to turn when they suspected doctor shopping, and they've been a huge help in developing these cases."

TennCare fraud is a Class E felony carrying a sentence of up to two years in prison per charge. District Attorney William H. Cox will prosecute.

The OIG, which is separate from TennCare, 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 $165 million for the TennCare program, according to latest figures. To date, over 920 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."