A Macon County woman is charged with TennCare fraud involving “doctor shopping,” or using TennCare to go to multiple doctors in a short time period to obtain prescriptions for controlled substances.
The Office of Inspector General (OIG) today announced the arrest of Leah M. Walker, 27, of Lafayette. Walker’s arrest was assisted by the Macon County Sheriff’s Office. Walker has been charged with one count of fraudulently using TennCare to obtain a controlled substance by “doctor shopping,” one count of TennCare fraud and one count of obtaining a controlled substance by fraud.
Charges against her say that Walker presented a pharmacy with a forged prescription for the painkiller Hydrocodone, which was paid for with TennCare. Authorities say it was during the investigation that it was discovered that Walker fraudulently obtained a controlled substance by “doctor shopping,” or failing to disclose to her physician that she had seen another physician within a 30-day period and received a prescription for the painkiller Oxycodone, using TennCare to pay for the physician visits.
"Certain prescription drugs are classified as controlled substances because they have a dangerous potential for abuse and addiction,” Inspector General Deborah Faulkner said. “TennCare pays for such medications when prescribed under the direction and supervision of a physician, but we’re committed to pursuing those cases involving fraud and abuse especially when these classifications of dangerous drugs are involved.”
TennCare fraud is a Class E felony carrying a sentence of up to two years in prison per charge, and obtaining a controlled substance by fraud is a Class D felony, punishable by two to four years in prison. District Attorney General Tom P. Thompson is prosecuting. The OIG, which is separate from TennCare, began full operation in February 2005 and has investigated cases leading to over $2.5 million paid in restitution and recoupment to TennCare, with a total estimated cost avoidance of over $171 million for the TennCare program, according to latest figures.
To date, over 1,300 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."