Rutherford County Woman Charged With TennCare Fraud

NASHVILLE – A Rutherford County woman has been indicted in Cannon County for TennCare fraud involving “doctor shopping,” or using TennCare benefits to go to multiple doctors in a short time period to obtain controlled substances, such as prescription painkillers.  

The Office of Inspector General (OIG), with assistance from the Cannon and Rutherford County Sheriff’s Offices, announced the arrest of Theresa Certain, 40, of Murfreesboro. Certain is charged with five counts of fraudulently using TennCare to obtain controlled substances by “doctor shopping.”

"The response to our efforts to crack down on people who are ‘doctor shopping’ in TennCare has been overwhelming from providers and law enforcement units across Tennessee,” Inspector General Deborah Faulkner said. “With this tool, we have an even stronger program to go after the prescription drug problem.” 

According to the indictment, Certain failed to disclose to her doctor while receiving prescriptions for Hydrocodone and prescription-strength Tylenol that she had previously seen other physicians within a 30-day period and had received similar prescriptions for the painkiller.  

TennCare fraud involving doctor shopping is a Class E felony carrying a sentence of up to two years per charge in prison. District Attorney General William Whitesell, Jr.  is prosecuting.

The OIG, which is separate from TennCare, was created by Governor Bredesen and began full operation in February 2005 and has investigated cases leading to over $2.6 million paid in restitution and recoupment to TennCare, with a total estimated cost avoidance of over $159 million for the TennCare program, according to latest figures. 

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.tncarefraud.tennessee.gov and follow the prompts that read "Report TennCare Fraud."