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June 24, 2013

TN OIG reports three mid-state TennCare fraud cases

The Tennessee Office of the Inspector General reports three new TennCare fraud cases involving prescription drugs in the mid-state area.  A Dickson County man is charged with TennCare fraud for selling prescription drugs that were paid for with TennCare healthcare insurance benefits. Additionally, two mid-state residents are charged in separate cases with TennCare fraud involving prescription drugs.

The Office of Inspector General (OIG) today announced the arrest of Michael J. Dotson, 40, of Dickson, after a joint investigation with the Dickson Police Department.

Dotson is charged with two counts of TennCare fraud accusing him of using TennCare benefits to obtain a prescription for the painkiller Morphine, a Schedule II controlled substance, by paying for the legitimate prescription with TennCare, while selling a portion of the drugs in Dickson County.

“We have made prescription drug abuse in TennCare a top priority – and it’s paying off in the number of arrests we make for this and related crimes. “There’s a multitude of healthcare providers and others who are watching for signs of prescription drug fraud across the state, and those involved will be arrested,” Inspector General Deborah Faulkner said.

healthcare-fraud-lprescriptiondrugs-lgThe Office of Inspector General (OIG) also announced the arrest of Constance Porter, 44, of Hartsville and 33-year old Adam Combs, of Lewisburg. The arrests were assisted by the 15th Judicial Drug Task Force and the Giles County Sheriff’s Office.

Porter is charged in a Trousdale County indictment with one count of TennCare fraud for obtaining TennCare benefits by means of willful false statement and concealment of material facts in order to obtain medical assistance benefits she was not entitled to.

Combs is charged in Maury County with one count of TennCare fraud for using TennCare benefits to obtain a prescription for Alprazolam, an anti-anxiety medication also known as Xanax, while planning to sell a portion of the prescription.

“Prescription drug fraud is a crime we can definitely stop, and the Office of Inspector General will continue to aggressively pursue TennCare members who commit this crime. “Local law enforcement officers feel the same way we do – TennCare fraud is unacceptable and will be stopped,” Inspector General Deborah Y. Faulkner said.

TennCare fraud is a Class E felony carrying a sentence of up to two years in prison per charge.  District Attorney General Dan M. Alsobrooks is prosecuting.

The OIG, which is separate from TennCare, began full operation in February 2005 and has investigated cases leading to over $3.5 million paid in restitution and recoupment to TennCare, with a total estimated cost avoidance of over $173 million for the TennCare program, according to latest figures.  To date, over 1,900 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 and follow the prompts that read “Report TennCare Fraud.”

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