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TennCare Fraud Office of Inspector General (History and Mission) Manny Tyndall Assistant Inspector General Special Agent Criminal Investigation Division. National Statistics. 2011 : 4.02 billion prescriptions written - - PowerPoint PPT Presentation
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Office of Inspector General 1
TennCare FraudOffice of Inspector General
(History and Mission)
Manny TyndallAssistant Inspector General
Special AgentCriminal Investigation Division
Office of Inspector General 2
National Statistics
2011: 4.02 billion prescriptions written -
2010: 16 million Americans reported nonmedical use of prescription drugs –
Prescription pain killers now leading cause of accidental death in U.S.
Source: www.whitehousedrugpolicy.gov/prescriptiondrugs/index.html
Office of Inspector General 3
Deaths by Age: Opioid Pain Relievers vs. Illegal Drugs (National Statistics 2010)
Source: CDC, Morbidity and Mortality Weekly Report, 60(43): 1489, 2011Source: CDC, Morbidity and Mortality Weekly Report, 60(43): 1489, 2011
Office of Inspector General 4
Deaths from Opioid Pain Relievers vs. Illegal Drugs (National Statistics 2010)
Source: CDC, Morbidity and Mortality Weekly Report, 60(43): 1489, 2011Source: CDC, Morbidity and Mortality Weekly Report, 60(43): 1489, 2011
Office of Inspector General 5
Tennessee Statistics
18+ million prescriptions were written for controlled substances in 2012.
Among top states in the nation for: prescriptions written; Hydrocodone & Oxycodone sales; drug overdose deaths
Neonatal Abstinence Syndrome
Office of Inspector General 6
Top 10 Prescriptions in TN (2012)
Office of Inspector General 7
All Prescriptions in TN (2012)
Office of Inspector General 8
Overdose Deaths in Tennessee (2011)
1,062 drug overdose deaths
TN 16.6 per 100,000 US 12.9 per 100,000
Middle TN: 2011: 3942012: 424
Nationwide: 16,500
Office of Inspector General 9
TennCare Statistics
1.2 million people on TC (20%) –Average annual cost of recipient
$3,656.00
Budget for TC: 2012 - $9.4 billion
Pharmacy budget: $733 million
Office of Inspector General 10
Pharmacies in Local AreaCITY PHARMACIES
Nashville 133
Franklin 42
Clarksville 37
Dickson 13
Spring Hill 12
Ashland City 9
Fairview 9
Erin 9
Waverly 9
McEwen 9
Kingston Springs 4
Jackson 31
Memphis 207
Office of Inspector General 11
Illegal Prescription Drug Sales
Hydrocodone (Lorcet; Lortab; Norco; Vicodin) - sells for $6.00 - $8.00 each
Oxycodone/Oxycontin (Percocet; Percodan; Tylox) - usually $1.00 per mg
Morphine sells for: 30mg - $30; 60mg - $45; 100mg - $60 (sometimes $1.00 per mg)
Methadone $10 - $40 per dose
Opana (Oxymorphone) $1.00 per mg
Office of Inspector General 12
OIG Launched
July 1, 2004OIG officially launched
independent of Bureau of TennCarereporting directly to the
Commissioner of Finance and Administration
focus on applicants/recipients
TBI Medicaid Fraud Control Unit (MFCU) Providers
Office of Inspector General 13
OIG Mission and Goal
The mission of the Office of Inspector General is to identify, investigate, and prosecute persons who commit fraud
and abuse against the TennCare program.
The goal is to save the State of Tennessee and the TennCare program
money by finding fraud and abuse, stopping it, and recovering monies
owed to the state.
Office of Inspector General 14
Health Oversight & Law Enforcement
The Office of Inspector General
functions as both a health oversight and law enforcement agency and is authorized to obtain pertinent health
information upon request.
TCA § 71-5-2609
Office of Inspector General 15
InspectorGeneral
Organizational Structure
CriminalInvestigation
Division
Legal DivisionCriminal
&Civil
EligibilityIntegrityDivision
Drug Diversion
Team
Office of Inspector General 16
Primary Criminal Case Types
living out-of-state
ineligible person(s) using benefits
nursing home – estate cases theft of services
resource/assets
Office of Inspector General 17
Primary Criminal Case Types
drug diversion: 75 – 80% of cases
“Any criminal act involving a prescription drug”
forged, altered prescriptions
selling prescriptions
obtaining a controlled substance by fraud
sale of medication paid for by TennCare
“doctor shopping”
Office of Inspector General 18
Criminal
Civil
Arrests – 1,950
Restitution & Arrests
Office of Inspector General 19
Types & Number of ArrestsAccess to Insurance 55
Drug Diversion - Sale/Forgery 1287
Doctor Shopping 286
Ineligible Persons Using TennCare 20
Asset Diversion 7
Resource/Income 80
Out of State 32
Identity Theft 66
Aiding & Abetting 7
Child Not in Home 21
DEA Task Force 38
Falcon III & IV 48
Failure to Appear 3
Total Arrests 1,950
80.6%
Office of Inspector General 20
Number of Arrests: Race & Gender
NOTE: Some individuals may have been arrested more than onceNOTE: Some individuals may have been arrested more than once
Office of Inspector General 21
Number of Arrests by Age
AGE COUNT
16 - 20 68
21 – 25 215
26 - 30 294
31 – 35 326
36 - 40 257
41 – 45 213
46 – 50 158
51 – 55 125
56 – 60 80
61 – 65 53
66 - 70 20
71 - 75 8
76 - 80 2
Office of Inspector General 22
Hotline Number1 (800) 433-3982
Law Enforcement
Providers
Anonymous
State Agencies
?
R x
Sources of Information
Office of Inspector General 23
Press Releases and Print Media
Briefings, Presentations, In-Service
Broadcast Media
Spread The Word
Office of Inspector General 24
Posters
English and Spanish
Office of Inspector General 25
Hotline Number: (800) 433-3982
Main Line: (615) 687-7000
http://www.tn.gov/tnoig
Media Releases; Statistics; Definitions;
How to Report Fraud.
Contact Information
Office of Inspector General 26
SUMMARYTennCare fraud and more specifically prescription drug diversion is a problem facing every county in the state.
No one agency can be as successful as a number of agencies working together.
We need to work together to combat TennCare fraud -- especially prescription drug diversion.
If a person has ever committed TennCare fraud or if they are now committing TennCare fraud (in state or out-of-state), they can expect a visit from our office.
Office of Inspector General 27
QUESTIONS?
Criminal Investigation Division