Knox County Man Charged with TennCare Drug Fraud

NASHVILLE – A Knox County man has been charged with using TennCare to pay for fraudulent prescription drugs.

The Office of Inspector General (OIG) today announced the arrest of Joshua R. Shell, 21, of Knoxville.  The arrest was a joint effort with the Knox County and the Union County Sheriff’s Office.

Shell is accused of presenting a prescription that had been altered to include the painkiller Lortab at a pharmacy in Knoxville. The doctor’s visit that allowed Shell to obtain the prescription was paid for by TennCare.  He faces one count of TennCare fraud and one count of obtaining controlled substance by fraud.

“Pharmacies and other healthcare providers are much more alert now in spotting prescription fraud, because when it involves TennCare, we are pursuing those cases,” Inspector General Deborah Y. Faulkner said.  “We depend on the quick action of doctors, pharmacies and other providers to alert us to suspected TennCare fraud.”

Penalties for the charges against Shell include up to two years for the TennCare fraud charge, and up to four years for the obtaining controlled substance by fraud. District Attorney Randall Nichols is prosecuting.

TennCare fraud is a class E felony carrying a sentence of up to two years per charge in prison.  Identity theft and the forged prescription charges are class D felonies that carry a sentence of up to four years per charge in prison. District Attorney General John W. Carney will be prosecuting.

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."