TennCare Fraud Unit Marks 1,000 Busts

The Bureau of TennCare says more than 1,000 people have now been charged with fraud against the health care program since the TennCare Office of Inspector General was created four years ago.
That comes from a news release Monday, with said a couple of busts in Putnam County pushed the total over 1,000. Today’s there’s a release on two more arrests, which would make 1,002.
Beyond the release, it’s fair to say that the amount of rhetoric over “waste, fraud and abuse” in TennCare has also dramatically fallen in the past four years. Of course, Gov. Bredesen’s slashing of the TennCare enrollment might have something to do with that, too.
Back to the release:
“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.”
For a list of “Quick Facts” about the TennCare fraud operation, click below.

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

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