TENNCARE DRUG RESALE INVESTIGATION WIDENS

TBI Checking To See If doctors In Scam

TennCare and the TBI have joined Metro police to investigate how an
east Nashville family ended up with TennCare prescription drugs they
sold on the streets.

The Nashville case involves Mary Francis Denton, 59, and her
granddaughter, Misty Bryan Allen, 22, of McClurkin Avenue. They were
arrested on drug charges Monday after police said they sold
painkillers OxyContin, methadone and Lortab illegally after obtaining
the medications by being on TennCare.

TennCare officials would not say how long the two had been on
TennCare, citing rules that protect enrollees' privacy. It was unclear
yesterday whether Denton and Allen are still eligible for TennCare
benefits, Potter said.

TennCare is investigating what kinds of services the women got and how
they got them, said Lola Potter, spokeswoman for the newly created
TennCare Office of Inspector General.

The post, created by Gov. Phil Bredesen earlier this year, is headed
by Deborah Faulkner, former acting chief of Metro police.

At the same time, the Tennessee Bureau of Investigation is looking
into whether doctors writing prescriptions and other providers were
part of the scam, Potter said.

TennCare does not require co-payments for drugs or place limits on how
many an enrollee can get.

A plan by Bredesen to place limits on TennCare enrollees would not
necessarily crack down on this kind of abuse.

Medicaid enrollees would not be required to pay co-payments, and 80%
of enrollees would not be subject to limits of six prescriptions per
month.

A more aggressive office of in-spector general, which is hiring 71
more staffers and undercover agents, should help, Potter said.

Last calendar year, the TennCare fraud and abuse unit handled about
30,000 tips, most of them dealing with enrollees not truthful about
income and access to private health insurance, Potter said.

Similar cases to the east Nashville incident happen but are not
common, Potter said. She did not know how many such cases were under
investigation.

Once a TennCare enrollee is jailed on either drug or other offenses,
he or she is taken off of the program, Potter said. The state is
awaiting word from the federal government whether it can allow
TennCare to drop coverage of people who have violated fraud and abuse
laws but have not been convicted, Potter said.