State cracking down on TennCare enrollee fraud

Photo by Kristen Luther
TennCare officials are cracking down on enrollee prescription drug fraud in 10 counties, including Carter County. Investigators hired by TennCare are targeting 9,300 enrollees who have filled suspicious prescriptions, including getting narcotics from multiple doctors at various pharmacies.

  NASHVILLE -- Some TennCare recipients in Carter County will be among those receiving a notice regarding their practice of traveling to pharmacies more than 100 miles from their home to have fraudulent prescriptions filled.
  The notices are part of an effort by TennCare investigators to crack down on prescription drug fraud. TennCare officials are targeting 9,300 enrollees who have filled suspicious prescriptions such as getting narcotics from multiple doctors at various pharmacies.
  Almost 8,000 enrollees had at least three drug claims involving a pharmacy more than 100 miles from their home within a 30-day period. TennCare Inspector General Deborah Faulkner said in a news release issued Thursday that roughly 1,400 letters were sent to recipients who used more than three different pharmacies and more than four different doctors to obtain narcotics within a four-day period.
  The enrollees were given 14 days to contact TennCare and explain the behavior. Faulkner said some recipients will lose their benefits and others will go to jail. TennCare enrollee fraud is a felony.
  In the case of recipients who traveled more than 100 miles to pharmacies, a total of 155,251 prescriptions were filled, totaling nearly $15 million in prescription drug costs. Faulkner said of those 7,967 members, the top ten counties with enrollees receiving the letters, in addition to Carter County, were Shelby, Hamilton, Davidson, Hamblen, Knox, Sumner, Giles, Sullivan and Scott.
  The 1,406 recipients who may be using pharmacies or doctors excessively to get drugs obtained 11,439 total prescriptions. The top ten counties that these letters were generated to were: Shelby, Knox, Davidson, Sumner, Madison, Rutherford, Hamilton, Blount and Bradley.
  At the top of the list of prescription drugs obtained by these members is hydrocodone, a powerful and addictive narcotic, as well as valium and other sedatives, anti-depressants and anti-anxiety medications, sleep inducers, and pain relievers.
  "TennCare could 'lock-in' the members to one specific pharmacy, limiting their ability to obtain controlled substances and multiple prescriptions - or, where justified, the state could pursue TennCare fraud charges," Faulker said in the news release.
  Inspector General Faulkner was appointed this summer by Gov. Bredesen after the General Assembly passed legislation creating the division to go after TennCare fraud in a greater effort than the program has seen. So far, Faulkner has hired 40 new investigators, attorneys, medical professionals and other staff who are sorting through information for specific patterns of enrollee and provider behavior.