Two Shelby County Women Charged with TennCare "Doctor Shopping"

NASHVILLE - Two Shelby County women are charged with “doctor shopping” with TennCare, or going to multiple doctors in a short period to obtain the same or similar controlled substances and using the state’s public healthcare insurance program as payment.

The Office of Inspector General (OIG), with assistance from the Shelby County Sheriff’s Department, today announced the arrest of Kimberly D. Pointer, 40, of Memphis, and Jamie M. Carter, 30, of Cordova. They were each arrested on a warrant charging them with one count of fraudulently using TennCare to obtain a controlled substance by “doctor shopping.”

Both women visited multiply prescriptions within a 30-day period, receiving prescriptions for the painkiller Hydrocodone.  In both cases, the physician office visits or the prescriptions were paid for by TennCare.

"The ‘doctor shopping’ law passed by the Legislature is a valuable tool in cracking down on people who are abusing the program,” Inspector General Deborah Faulkner said. “Physicians across the state have applauded this law and our efforts to stop people from doing this and are helping us develop these cases.”

TennCare fraud is a Class E felony carrying a sentence of up to two years per charge in prison. District Attorney General Amy T. Weirich will be prosecuting both cases.

The OIG, which is separate from TennCare, began full operation in February 2005 and has investigated cases leading to over $3.5 million paid in restitution and recoupment to TennCare, with a total estimated cost avoidance of over $173 million for the TennCare program, according to latest figures.  To date, nearly 1,500 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."