Hamilton County Woman Charged with TennCare "Doctor Shopping"

NASHVILLE – A Hamilton County woman is indicted in Knox County 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) today announced the arrest of Janet Kay Evans, 47, of Hixson, who turned herself in at the Knox County Sheriff’s Office. Evans has been charged with two counts of obtaining a controlled substance by fraud and two counts of fraudulently using TennCare to obtain a controlled substance by “doctor shopping.”  She’s accused of receiving prescriptions for the same or similar controlled substances from multiple doctors within a 30-day period without revealing the visits to any of the physicians. The office visits were billed to TennCare.

"The ‘doctor shopping’ law passed by the Legislature is a valuable tool in cracking down on people who are abusing the program by going from doctor to doctor to get pills – most often, pain pills,” Inspector General Deborah Faulkner said. “Physicians across the state have applauded this new law and our efforts to stop people from doing this and are helping us develop these cases.”

TennCare fraud is a class E felony carrying a sentence of up to two years in prison per charge, and obtaining a controlled substance by fraud is a class D felony, punishable by two to four years in prison per charge. District Attorney General Randall Nichols 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 1,300 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."