Department of Finance & Administration
Dave Goetz, Commissioner

TENNCARE FRAUD ARRESTS BY OIG REACH 1,000 MARK

NASHVILLE, Tenn. – The arrest of two people named in Putnam County indictments brings to 1,000 the total number of people charged with TennCare fraud since the Office of Inspector General (OIG) was formed and given authority to pursue fraud cases.

The OIG today announced the two arrests – both accused of prescription drug fraud within the TennCare program.

The OIG became fully operational in February of 2005, after Governor Phil Bredesen led the push for legislation creating the unit, and laws supporting its efforts.

“As more and more people are interested in prescription drugs instead of ‘street’ drugs, I think our efforts will be even more in demand,” Inspector General Deborah Y. Faulkner said. “We’re certainly not going to slow down at 1,000, as our agents are in the field today pursuing cases.”

Angela S. Tindle, 36, of Cookeville, was charged with four counts of TennCare fraud for using TennCare to pay for forged prescriptions on four separate occasions for the painkiller Hydrocodone, two preparations of insulin – humulin and novolin, and syringes.

Jamie L. Bowman, 36, of Baxter was charged with four counts of TennCare fraud.  Bowman is accused of using TennCare to pay for fraudulent prescriptions for the painkiller hydrocodone on four separate occasions.

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, 1,000 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."

OIG QUICK FACTS:

February 2005:      OIG becomes fully operational and pursuing cases.

June 2005:            OIG receives authority to offer cash rewards for information that leads to convictions for TennCare enrollee fraud.

November 2006:    OIG achieves accreditation from the Commission on Accreditation for Law Enforcement Agencies (CALEA).

June 18, 2007:      Governor Phil Bredesen signs “doctor shopping” bill passed by legislature, making it a crime to use TennCare to go to multiple doctors within a 30-day period to get prescriptions for the same or similar medications.

October 2007:       The conviction of a Kentucky resident charged with misrepresenting her residency in order to obtain TennCare benefits led to the state's first TennCare fraud "Cash for Tips" award from the OIG.   

December 2007:    OIG makes first “doctor shopping” arrest.  

December 2008:    OIG makes a record 35 arrests for one month; also logging a record 262 arrests made during one year for the OIG unit.

Total number of arrests from February 2005 to August 18, 2009:  1,000

Number of arrests involving prescription drugs:  772

Number of arrests involving “doctor shopping:” 83

Number of arrests involving identity theft in addition to TennCare fraud: 28

Number of arrests involving people who had access to insurance but committed fraud to obtain or maintain TennCare benefits: 55

Amount of recoupment to TennCare:  $1.32 million

Restitution collected: $1.27 million

Potential savings (cost avoidance): $171 million

Recoupment through civil cases: $470,000