Franklin County Woman Charged with TennCare "Doctor Shopping"

NASHVILLE – A Franklin County woman is charged in an indictment with TennCare fraud involving “doctor shopping,” or using TennCare to visit multiple doctors in a short time period for controlled substance prescriptions.

The Office of Inspector General (OIG) with the assistance of the Estill Springs Police Department today announced the arrest of Pamela D. Sims, 37, of Estill Springs.  She is charged with one count of fraudulently using TennCare to obtain a controlled substance by “doctor shopping.”

Sims is accused of failing to tell her doctor that she had seen another healthcare provider within a 30-day period and received a prescription for the strong painkiller Oxycodone, with the physician office visits and prescriptions being paid for by TennCare.

"The ‘doctor shopping’ arrests we’ve made since the 2007 law was signed by Governor Bredesen have nearly all involved prescription painkillers, muscle relaxants, anti-anxiety drugs – medications that can be addictive and alter the body, mind, or both,” Inspector General Deborah Faulkner said.  “People who seek these drugs by abusing TennCare run a high risk of getting caught, going to jail, or having to repay TennCare for the benefits that were fraudulently obtained.”

TennCare fraud is a Class E felony carrying a sentence of up to two years per charge in prison.  District Attorney General J. Michael Taylor will be prosecuting this case.

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 1,000 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."