Sumner County Woman Charged With TennCare "Doctor Shopping"

NASHVILLE – A Sumner County woman has been indicted for TennCare fraud involving “doctor shopping,” which is the crime of using TennCare to go to multiple doctors in a short time period to obtain controlled substances.

The Office of Inspector General (OIG) with the assistance of the Portland Police Department today announced the arrest of Melanie M. McKenzie, 22, of Portland.  She is charged with five counts of fraudulently using TennCare to obtain controlled substances by “doctor shopping.”

The arrest warrants say McKenzie failed to disclose to a doctor that she had seen other physicians within a 30-day period and received prescriptions for the strong painkiller Hydrocodone with the physician office visits being paid for by TennCare.  Charges against McKenzie were served when she appeared a Sumner County court on related charges.

"The response we have received from doctors across the state has been overwhelmingly in support of the state cracking down on people who try to ‘doctor shop,’” Inspector General Deborah Faulkner said. “Before the ‘doctor shopping’ law, physicians really had no alternatives that would ensure justice is served against people committing this crime with TennCare benefits.”  

TennCare fraud involving doctor shopping is a Class E felony carrying a sentence of up to two years per charge in prison with one count being an Class A misdemeanor carrying a fine of up to $2,500. District Attorney General Lawrence R. Whitley 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 1,050 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."