Two individuals have been charged with TennCare fraud in connection with using TennCare to purchase controlled substances, according to the Office of Inspector General (OIG) for the Tennessee Department of Finance and Administration. TennCare is Tennessee’s Medicaid managed care program that provides health coverage for 1.2 million low-income children, pregnant women, and the disabled. In one case, a woman was accused of doctor shopping to obtain painkillers, and in the other case, a man was charged with aiding and abetting his wife in her attempts to obtain a controlled substance and then resell a portion of the substance.
The man, a Hamilton County Tennessee resident, was charged with aiding and abetting his wife in her use of TennCare benefits to obtain Subutex, a prescription opioid used to treat heroin addiction. The two later planned on selling a portion of the prescription. “It is unfortunate when people use TennCare this way,” said Inspector General Deborah Y. Faulkner.
The woman, a Rutherford County Tennessee resident, who was charged with doctor shopping, allegedly used TennCare to obtain the painkiller Lortab. The woman is accused of seeing multiple doctors to obtain multiple prescriptions for the drugs and using TennCare as payment. The woman was previously charged with four counts of doctor shopping by a grand jury.
Both individuals were charged with TennCare fraud which is a Class E felony under Tennessee law. Each charge carries a maximum two year sentence.
The Tennessee OIG has investigated cases leading to over $3.5 million in recoupment and restitution to the TennCare program and saved another $173 million in potential fraud. To date, over 1700 individuals have been charged with TennCare fraud. The Tennessee OIG is separate and not connected to the TennCare program.