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TennCare Fraud Office of Inspector General (History and Mission) Manny Tyndall

TennCare Fraud Office of Inspector General (History and Mission) Manny Tyndall Assistant Inspector General Special Agent Criminal Investigation Division. National Statistics. 2011 : 4.02 billion prescriptions written -

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TennCare Fraud Office of Inspector General (History and Mission) Manny Tyndall

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  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: www.whitehousedrugpolicy.gov/prescriptiondrugs/index.html Office of Inspector General

  3. Deaths by Age: Opioid Pain Relievers vs. Illegal Drugs (National Statistics 2010) Source: CDC, Morbidity and Mortality Weekly Report, 60(43): 1489, 2011 Office of Inspector General

  4. Deaths from Opioid Pain Relievers vs. Illegal Drugs (National Statistics 2010) Source: CDC, Morbidity and Mortality Weekly Report, 60(43): 1489, 2011 Office of Inspector General

  5. Tennessee Statistics 18+ million prescriptions were written for controlled substances in 2012. 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: 394 2012: 424 Nationwide: 16,500 Office of Inspector General

  9. TennCare Statistics 1.2 million people on TC (20%) – Average annual cost of recipient $3,656.00 Budget for TC: 2012 - $9.4 billion Pharmacy budget: $733 million Office of Inspector General

  10. Pharmacies in Local Area Office of Inspector General

  11. Illegal Prescription Drug Sales Hydrocodone (Lorcet; Lortab; Norco; Vicodin) - sells for $6.00 - $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 § 71-5-2609 Office of Inspector General

  15. Organizational Structure Inspector General Legal Division Criminal & Civil Drug Diversion Team Criminal Investigation Division Eligibility Integrity Division 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. Restitution & Arrests Criminal Civil Arrests – 1,950 Office of Inspector General

  19. Types & Number of Arrests Office of Inspector General

  20. Number of Arrests: Race & Gender NOTE: Some individuals may have been arrested more than once Office of Inspector General

  21. Number of Arrests by Age Office of Inspector General

  22. Sources of Information Rx Hotline Number 1 (800) 433-3982 Tenncare.Fraud@tn.gov Law Enforcement Providers Anonymous State Agencies ? Office of Inspector General

  23. Spread The Word Press Releases and Print Media Broadcast Media Briefings, Presentations, In-Service Office of Inspector General

  24. Posters English and Spanish Office of Inspector General

  25. Contact Information Hotline Number: (800) 433-3982 Main Line: (615) 687-7000 TennCare.Fraud@tn.gov http://www.tn.gov/tnoig Media Releases; Statistics; Definitions; How to Report Fraud. 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 Office of Inspector General

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