Office of Inspector General 1 TennCare Fraud Office of Inspector General (History and Mission) Manny Tyndall Assistant Inspector General Special Agent Criminal 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:

Office of Inspector General 3 Deaths by Age: Opioid Pain Relievers vs. Illegal Drugs (National Statistics 2010)

Office of Inspector General 4 Deaths from Opioid Pain Relievers vs. Illegal Drugs (National Statistics 2010)

Office of Inspector General 5 Tennessee Statistics  18+ million prescriptions were written for controlled substances in  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: : 424  Nationwide: 16,500

Office of Inspector General 9 TennCare Statistics  1.2 million people on TC (20%) –  Average annual cost of recipient  $3,  Budget for TC: $9.4 billion  Pharmacy budget: $733 million

Office of Inspector General 10 Pharmacies in Local Area CITY PHARMACIES Nashville133 Franklin42 Clarksville37 Dickson13 Spring Hill12 Ashland City9 Fairview9 Erin9 Waverly9 McEwen9 Kingston Springs4 Jackson31 Memphis207

Office of Inspector General 11 Illegal Prescription Drug Sales  Hydrocodone ( Lorcet; Lortab; Norco; Vicodin ) - sells for $ $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, 2004 OIG officially launched independent of Bureau of TennCare reporting 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 §

Office of Inspector General 15 Inspector General Organizational Structure Criminal Investigation Division Legal Division Criminal & Civil Eligibility Integrity Division 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 Arrests Access to Insurance55 Drug Diversion - Sale/Forgery1287 Doctor Shopping286 Ineligible Persons Using TennCare20 Asset Diversion7 Resource/Income80 Out of State32 Identity Theft66 Aiding & Abetting7 Child Not in Home21 DEA Task Force38 Falcon III & IV48 Failure to Appear3 Total Arrests1, %

Office of Inspector General 20 Number of Arrests: Race & Gender

Office of Inspector General 21 Number of Arrests by Age AGECOUNT – – – – – – –

Office of Inspector General 22 Hotline Number 1 (800) Law Enforcement Providers Anonymous State Agencies ? RxRx Sources of Information

Office of Inspector General 23 Spread The Word

Office of Inspector General 24 Posters English and Spanish

Office of Inspector General 25 Hotline Number: (800) Main Line: (615) Media Releases; Statistics; Definitions; How to Report Fraud. Contact Information

Office of Inspector General 26 SUMMARY TennCare 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