Pubdate: Fri, 31 Dec 2004
Source: Tennessean, The (TN)
Copyright: 2004 The Tennessean
Author: Anita Wadhwani


State efforts to crack down on TennCare fraud have been met with criticism
by the American Civil Liberties Union and lawyers for the 1.3 million poor
and uninsured people in Tennessee's health insurance program. In some cases,
the state has been incorrectly telling recipients they may have broken the
law, the lawyers say.

In the past month, TennCare has mailed out nearly 12,500 letters to
TennCare users who the state says appeared to have underreported their
income or whose patterns of prescription drug use appear suspicious.
The letters tell people to explain their actions in writing within 14
days. One version of the letter tells recipients they face prosecution
or jail time for failing to report to TennCare.

State officials say the letters represent a renewed commitment on the
part of TennCare to restore faith in the $8.7 billion program, often
criticized for fraud. ''We're looking at the people who are lying,
cheating and stealing from the people of Tennessee,'' said Deborah
Faulkner, who heads the TennCare Office of Inspector General, a state
watchdog agency created in July by Gov. Phil Bredesen to investigate
TennCare user fraud.

''At the same time, there are very deserving people on TennCare.
That's not who we're after.'' The ACLU and the Tennessee Justice
Center, a nonprofit legal agency that represents TennCare users in
federal court, say the agency's efforts are casting too wide a net
that may include many innocent TennCare users. ACLU of Tennessee
Director Hedy Weinberg says the letters are intimidating and ask
people to turn themselves in, violating the constitutional rights of
enrollees to not incriminate themselves, while the Justice Center says
the letters are difficult to understand and contain inaccurate
information about the law. ''The tone is quite intimidating, and it
shows a disregard for the constitutional protections of recipients,''
Weinberg said. ''It's important that a state agency respect
constitutional rights.

We are not in any way advocating breaking the law but .TennCare
recipients should know they have protections under the Fifth
Amendment'' to not report their own criminal behavior. Tennessee
Justice Center attorney Gordon Bonnyman said he finds fault with the
letters telling recipients that it's illegal to not tell their doctor
if they have received drugs from another doctor.

''That's not against the law. This is going to be very intimidating to
someone who says, ''Oh, my gosh, I didn't tell my doctor about this.''
Weinberg wrote a letter to the Office of Inspector General asking it
what actions it would take to guarantee the constitutional rights of
those who received the letters, what information the office can
legally compel from the recipients, and what the office intends to do
with the information. State lawyers are reviewing the ACLU's comments
and will respond, Faulkner said. ''We appreciate their input.

We always want to make sure we do a good job and ensure we have valid
information.'' Faulkner said one goal of the letters was to educate
TennCare users about their responsibilities to report changes in their
situations, such as pay raises or a chance to get private insurance.

Another goal was to help ferret out pharmaceutical abuse as part of an
overall effort to stem rising drug costs in the program, she said. The
governor has cited drug costs as a large part of TennCare fiscal
problems. The letters were generated after examining computer records,
Faulkner said. Officials compared wage information filed with the
state by Tennessee employers to incomes that TennCare users reported
to the agency.

That search turned up about 3,100 people who appear to have
underreported their monthly income by at least $1,500, Faulkner said.
Each got a letter with a 14-day deadline to explain the income disparity.

Nearly 8,000 TennCare users were found to have traveled more than 100
miles away to fill at least three different prescriptions recently.

They got another letter asking them to explain why they traveled so
far to fill their prescriptions.

Another group of about 1,400 received letters when computer records
found they had visited more than three different pharmacies or four
different health-care providers for narcotic drugs in a one-month
period. Faulkner said the response to the letters so far has been
good, with some offering explanations and others pulling out of
TennCare. To report fraud The TennCare Office of Inspector General has
set up several ways for the public to report TennCare fraud.

They include:
Phone: 1-800-433-3982
Fax: 615-256-3852
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MAP posted-by: Larry Seguin