Report Tenn Care Fraud

Posted in the Jamestown Forum

Medusa

Livingston, TN

#1 Oct 27, 2008
OVERTON COUNTY MAN CHARGED WITH TENNCARE FRAUD
NASHVILLE - An Overton County man is charged with TennCare fraud for selling prescription drugs he obtained by using TennCare.



The Office of Inspector General (OIG) today announced the arrest of 41-year old Ricky W. Smith, of Livingston. The arrest was the result of a joint effort with the Overton County Sheriff’s Office.



For the past ten months, Smith has been a fugitive from justice, indicted in Overton County in January of this year. His whereabouts were unknown until last week. He was indicted on charges of obtaining a prescription for the painkiller Avinza, a form of Morphine, using TennCare to pay for the prescription, and then selling a portion of it.



“Drug diversion – selling prescription drugs – will not be tolerated in the TennCare program,” Inspector General Deborah Y. Faulkner said.“People who participate in selling drugs paid for by TennCare – and those who buy them – should understand this is a serious crime we intend to prosecute.”



TennCare fraud is a Class E felony carrying a sentence of up to two years in prison. District Attorney General Randall York is prosecuting.



The OIG, a law enforcement agency separate from TennCare, began full operation in February 2005 and has worked cases leading to the arrest of over 770 individuals for TennCare fraud, with nearly $1 million paid in restitution to TennCare, and total estimated cost avoidance in TennCare of over $122 million, 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."



Medusa

Livingston, TN

#2 Oct 27, 2008
Christy Staggs, 35, of Overton County, was arrested October 2007 on charges of presenting a pharmacy with forged prescriptions for Avinza, a form of Morphine, and Alprazolam, the anti-anxiety medication also known as Xanax, and using TennCare to pay for the drugs. Staggs pleaded guilty to one count of TennCare fraud, receiving two years probation and she was ordered to pay almost a thousand dollars in restitution to TennCare. The court also ordered that Staggs cannot enroll in TennCare for a period of two years from the date of the plea.
Medusa

Livingston, TN

#3 Oct 27, 2008
The Office of Inspector General (OIG) today announced the arrest of David G. Davis, 42, and Daniel R. Huddleston, 27, both of Byrdstown. The arrests are the result of a joint effort with the Pickett County Sheriff’s Office.

Both Davis and Huddleston were arrested on separate indictments for fraudulently obtaining prescription drugs using TennCare. TennCare paid for Davis’ transportation to and from his provider to obtain a prescription for Hydrocodone; Huddleston used TennCare to pay for both his prescription of Oxycodone and the provider visit. After obtaining the prescriptions, Davis and Huddleston resold a portion of the pills to an undercover agent.

“People who use TennCare in any way to access prescription drugs for resale can be prosecuted for TennCare fraud,” Inspector General Deborah Y. Faulkner said.“Prescription drug abuse is a problem all communities in Tennessee are working to eliminate.”
Medusa

Livingston, TN

#4 Oct 27, 2008
CUMBERLAND COUNTY MAN CHARGED WITH TENNCARE “DOCTOR SHOPPING”
NASHVILLE – A Cumberland County man has been indicted in Hamilton County for “doctor shopping,” or going to multiple doctors in a short time period to get prescriptions for similar painkillers, and using TennCare to pay for the visits.

The Office of Inspector General (OIG) today announced the arrest of Craig E. Lindsey, 40, of Crossville. He is charged with two counts of fraudulently obtaining prescription painkillers by “doctor shopping.” Lindsey failed to disclose to his doctor that he had seen another physician within a 30-day period and received prescriptions for the painkillers Oxycodone and Oxymorphone. Both physician office visits were paid for by TennCare. Lindsey was in the Cumberland County Detention Center for other charges at the time he was served.

“For years, there was nothing we could do about this crime – but with the new ‘doctor shopping’ law the OIG can help put a stop to this outrageous behavior and misuse of TennCare benefits,” Inspector General Deborah Faulkner said.“Physicians across the state have welcomed the opportunity to do something about this problem.”

TennCare fraud is a Class E felony carrying a sentence of up to two years per charge in prison. District Attorney General William H. Cox is prosecuting.

The OIG, a law enforcement agency separate from TennCare, began full operation in February 2005 and has worked cases leading to the arrest of over 750 individuals for TennCare fraud, with nearly $1 million paid in restitution to TennCare, and total estimated cost avoidance in TennCare of over $122 million, 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."
Medusa

Livingston, TN

#5 Oct 27, 2008
TWO OVERTON COUNTY RESIDENTS CHARGED WITH TENNCARE FRAUD
NASHVILLE, TN – A man and woman from Overton County are charged with TennCare fraud for obtaining prescription medications through TennCare with the intent of selling the drugs.

The Office of Inspector General (OIG) announced the arrest of Lisa A. Beaver, 34, of Hilham and Eddie D. Ray, 52, of Allons. Both arrests were assisted by the Overton County Sheriff’s Office.

Beaver was charged with two counts of TennCare fraud for selling the painkiller Hydrocodone and the anti-anxiety medication Xanax to an undercover agent. These prescriptions were obtained by using her TennCare benefits.

Ray was charged with two counts of TennCare fraud for selling Oxycontin to an under cover agent on two separate occasions. TennCare paid for the provider’s visit at the time the prescription was written.

“The illegal trafficking of TennCare drugs is a problem across the state, and we simply will not tolerate it,” Inspector General Deborah Y. Faulkner said.“Enrollees who participate in selling drugs paid for by TennCare – and those who buy them – should understand this is a serious crime we intend to prosecute.”
Medusa

Livingston, TN

#6 Oct 27, 2008
RESTITUTION ORDERED IN OVERTON CO. TENNCARE FRAUD CASES
NASHVILLE – Nine people who pleaded guilty to TennCare fraud have been ordered to pay restitution as a result of arrests made last October in an Overton County drug round-up. Last year’s arrests were the result of a joint undercover operation involving the Office of Inspector General (OIG), County District Attorney General’s Office and the Overton County Sheriff’s Department.

“An undercover operation was launched in January 2007, when we began receiving tips that citizens could get fraudulent prescriptions filled at Clark’s Pharmacy,” said Overton County Detective Greg Etheredge, the lead investigator in these cases.“Our investigation revealed that individuals were taking fraudulent or altered prescriptions to Clark’s Pharmacy, where there was a ‘no questions asked’ policy by the pharmacist regarding the validity of a prescription.”

Investigators found that thousands of suspected forged prescriptions were filled at Clark’s Pharmacy between 2003 and 2006, and many individuals traveled across Tennessee to get prescriptions filled at Clark’s Pharmacy.

The following individuals have been sentenced, with restitution ordered totaling $57,199.78:

Sharon D. Willis, 41, who pleaded guilty to four counts of TennCare fraud and sentenced to two consecutive two-year for a total of four years supervised probation. Willis was ordered to pay TennCare restitution in the amount of $26,730.88.
Jeffery E. Fulton, 47, who pleaded guilty to three counts of TennCare fraud and one count of theft of services over $10,000, a Class C Felony. Fulton received a three year sentence suspended to three years supervised probation. He was also ordered to pay TennCare restitution in the amount of $12,422.96.
Julie Ann Conner, 43, who pleaded guilty to two counts of TennCare fraud, receiving a two year sentence suspended to two years supervised probation and ordered to pay restitution to TennCare in the amount of $8,968.00
Brian L. Fulton, 21, who pleaded guilty to one count of TennCare fraud and one count theft of services, a Class D felony, receiving a three years of supervised probation. Fulton has been ordered to pay restitution to TennCare in the amount of $2,688.18.
Rebecca J. Amonett, 43, who pleaded guilty to one count of TennCare fraud and one count of theft of services, receiving three years and six months of supervised probation and ordered to pay TennCare $3,002.62.
Leslie D. Yorke, 33, who pleaded guilty to two counts of TennCare fraud and one count theft of services, receiving a four year sentence suspended to four years supervised probation and ordered to pay TennCare $1,896.92 in restitution.
Linda Sue Smith, 42, who pleaded guilty to one count of passing a forged prescription, received a two year and 1 day sentence suspended to two years and one day supervised probation with 100 hours of community service. In exchange for her guilty plea, Smith’s TennCare charge was annulled but she was ordered to make restitution to TennCare in the amount of $734.22.
Lindsey E. West, 41, who pleaded guilty to one count of TennCare fraud and received a two year sentence suspended to two years supervised probation and ordered to pay TennCare restitution in the amount of $384.79.
Sherry L. Sisk, 39, who pleaded guilty to one count of TennCare fraud and received a two year sentence suspended to two years supervised probation and ordered to pay TennCare restitution in the amount of $371.21.
Medusa

Livingston, TN

#7 Oct 27, 2008
TWO PEOPLE ARRESTED IN CLAY COUNTY FOR TENNCARE DRUG FRAUD
NASHVILLE – A Clay County Grand Jury has charged two men with TennCare fraud related to attempting to sell prescription drugs paid for by TennCare.

The Office of Inspector General (OIG) today announced the arrests of Timothy E. Kernell, 30, of Gainesboro and Jack T. Rich, 64, of Celina. The arrests are the result of a joint effort with the Celina Police Department and the Clay County Sheriff’s Office.

Both Kernell and Rich were arrested on indictments alleging they each in separate incidents fraudulently obtained prescription drugs using TennCare to pay for the medication. After obtaining the prescriptions, Kernell and Rich resold a portion of the pills.

“The illegal trafficking of TennCare drugs is a problem across the state, and we simply will not tolerate it,” Inspector General Deborah Y. Faulkner said.“Enrollees who participate in selling drugs paid for by TennCare – and those who buy them – should understand this is a serious crime we intend to prosecute.”
Medusa

Livingston, TN

#8 Oct 27, 2008
OVERTON COUNTY MAN CHARGED WITH TENNCARE FRAUD
PART OF PREVIOUS TENNCARE, DRUG FRAUD SWEEP
NASHVILLE – The final arrest has been made in an undercover operation that started over a year ago, and involved more than 100 charges being made against a pharmacy owner in Overton County.

The Office of Inspector General (OIG) today announced that with the assistance of the Overton County Sheriff’s Office, Brian L. Fulton, 21, of Albany, Kentucky, finally surrendered. Fulton was indicted with 50 other people in the Upper Cumberland area who were arrested in an October 2007 sweep that also netted the owner of Clark’s Medical Center Pharmacy in Overton County. Fulton is charged with five counts of TennCare fraud and one count of theft of services for allegedly passing forged prescriptions at the pharmacy for Avinza, a form of morphine, the painkiller Hydrocodone and Carisoprodol, a muscle relaxer. He used TennCare to pay for the forged prescriptions.
Medusa

Livingston, TN

#9 Oct 27, 2008
NASHVILLE – Four people have been charged in separate indictments accusing them of TennCare fraud. The Office of Inspector General (OIG) today announced the arrests in Robertson, Putnam and Cheatham Counties.

The four are:


Janet Short Mundy, 35, of Greenbrier, indicted by a Robertson County Grand Jury on eight counts of TennCare fraud. She allegedly made false statements on her TennCare application, reporting that she had no income, lived with her parents and was not married. Mundy allegedly made these false statements approximately eight times during her recertification process. If convicted, she could be sentenced to up to two years per charge on the TennCare fraud charges. District Attorney General John W. Carney is prosecuting.

Donna F. Wright, of Cookeville, charged with one count of obtaining a controlled substance by fraud, one count of obtaining a legend drug and two counts of TennCare fraud for using TennCare to pay for the fraudulent prescription. Wright is accused of using TennCare to pay for altered prescriptions written for both Darvocet, a strong painkiller, and Levaquin, an antibiotic.

Kimberly D. Moore, of Cookeville, was indicted for one count of TennCare fraud and one count of fraudulently obtaining a controlled substance for presenting a prescription for Suboxone then using TennCare to pay for it, concealing the fact that she intended to sell a portion of it. Suboxone is a drug used to treat heroin and morphine addiction. It has some of the same effects as the two drugs. If convicted both Moore and Wright would face a two year prison sentence. Acting District Attorney Anthony J. Craighead is prosecuting.

Gail Givens, 27, of Kingston Springs was indicted in Davidson County on two counts of TennCare fraud for presenting an altered prescription for the painkiller Lortab on two separate occasions and using TennCare to pay for the medication. If convicted Givens could serve up to two years per count in prison. District Attorney Victor S. Johnson, III will prosecute this case.
Medusa

Livingston, TN

#10 Oct 27, 2008
NASHVILLE – Five people convicted of TennCare fraud have been sentenced in Macon, Overton and Cannon Counties. The Office of Inspector General (OIG) today announced the sentencing, which included loss of Medicaid benefits and restitution as part of probation.

Macon County: Michael Richard Jent, 40, pleaded guilty to one count of TennCare fraud for failing to disclose that he was enrolled in employer-sponsored health insurance, which in his case would have made him ineligible for TennCare. He was sentenced to probation for one year and as a condition, must repay TennCare $13,045.62.
Overton County: Iris S. Coning, 28, pleaded guilty to one count of TennCare fraud for using TennCare benefits to pay for forged prescriptions for the painkiller Oxycontin and Alprazolam, an anti-anxiety medication. She received two years of probation, and her TennCare/Medicaid privileges were suspended for two years.
Overton County: Eva D. Whited, 50, received a suspended two year sentence with probation after pleading guilty to four counts of TennCare fraud for presenting forged prescriptions for Ritalin to a pharmacy in Overton County and using TennCare to pay for the forged prescriptions. Whited’s TennCare/Medicaid privileges were suspended for two years and she was ordered to pay of small restitution of $355.04.
Cannon County: James W. Prater, 52, pleaded guilty to three counts of fraudulently obtaining the painkiller Lortab by “doctor shopping.” Prater obtained Lortab from three physicians within a 30-day period, all paid for by TennCare. Prater received consecutive one-year sentences on each count.
Cannon County: Jeffery R. Shelton, 45, pleaded guilty to two counts of TennCare Fraud and two counts of selling the painkiller Hydrocodone. At the same time, he pleaded guilty to two counts of selling marijuana, unrelated to his TennCare fraud charges. For all three offenses, Shelton was sentenced to jail for a total of five years. A suspended sentence has been scheduled for April 11, 2008.
Medusa

Livingston, TN

#11 Oct 27, 2008
MORGAN COUNTY WOMAN CHARGED WITH TENNCARE FRAUD
NASHVILLE – A Morgan County woman is charged with using another person’s TennCare card to pay for a prescription painkiller.

The Office of Inspector General (OIG) and the Morgan County Sheriff’s Office today announced the arrest of Lois Jeanne Watson, 29, of Oliver Springs.

An indictment charges Watson with one count TennCare fraud, one count of identity theft and one count of obtaining a controlled substance by fraud. Watson is accused of using the personal identification of a TennCare member to obtain a prescription for the drug Percocet.
Medusa

Livingston, TN

#12 Oct 27, 2008
NASHVILLE – With over three dozen people charged in one month with TennCare fraud, October has been a record breaking month for the Office of Inspector General (OIG).

The OIG today announced the arrest of 20-year-old Heather L. Davis of Oliver Springs. Davis faces one felony charge for fraudulently obtaining TennCare medical services by altering a prescription.

Davis was arrested on charges stemming from an indictment alleging that she fraudulently obtained a prescription for the painkiller Oxycodone. Although the drug had not been prescribed to her, Davis, used TennCare to pay for the fraudulent prescription.

"We are winning the war against TennCare fraud, and the front line of that battle is prescription drug fraud," Inspector General Deborah Faulkner said. "We will vigorously prosecute people accused of committing all TennCare fraud as well as those who attempt to abuse the program."

TennCare fraud is a Class E felony carrying a sentence of up to two years in prison. District Attorney General David Clark is prosecuting.

The OIG, a law enforcement agency separate from TennCare, began full operation in February 2005 and since that time has investigated cases leading to the arrest of over 562 individuals for TennCare fraud, with over $700,000 paid in restitution to TennCare, and total estimated cost avoidance in TennCare of over $75 million, 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."
Medusa

Livingston, TN

#13 Oct 27, 2008
OVERTON CO. PHARMACIST CHARGED WITH TENNCARE DRUG FRAUD
50 PEOPLE INDICTED, BEING ARRESTED IN WEEKEND ROUNDUP
NASHVILLE – The owner of an Overton County pharmacy is charged today with more than 100 charges including TennCare fraud, as 50 people in the Upper Cumberland area are being rounded up in related indictments.
The Office of Inspector General (OIG) and the Overton County Sheriff’s Office obtained indictments against Overton County pharmacist Malcolm D. Clark, doing business as Clark’s Medical Center Pharmacy. Indictments were also made against 50 pharmacy patrons for committing prescription drug fraud, and 22 of those face TennCare fraud charges involving prescription drug painkillers. Clark has been charged with more than a hundred counts related to illegally dispensing controlled substances.
“An undercover operation was launched in January, when we began receiving tips that citizens could get fraudulent prescriptions filled at Clark’s Medical Center Pharmacy,” said Overton County Detective Greg Etheredge, the lead investigator in the cases.“Our investigation revealed that numerous individuals would take their fraudulent or altered prescriptions to Clark’s Pharmacy, where there was a ‘no questions asked’ policy by pharmacist Doug Clark regarding the validity of a prescription.
“For years, this operation has bilked the system of millions of taxpayer dollars.”
Etheredge said that investigators from the Overton County Sheriff’s Department and the OIG followed the paper trail of thousands of suspected forged prescriptions that were filled at Clark’s Pharmacy between 2003 and 2006, by individuals across Middle Tennessee.
“A number of individuals traveled as far as a hundred miles to get their prescription filled at Doug Clark’s Pharmacy,” Etheredge said.“The investigation uncovered a variety of different types of forged prescriptions – anyone could spot the obvious changes to prescription quantities for the prescribed medications.
“Among the most surprising were prescriptions for the powerful drug morphine that were nothing more than copy paper without a doctor’s signature, accepted and filled by pharmacist Doug Clark.”
More than a half-dozen law enforcement agencies assisted the OIG and the Overton Sheriff’s Office, including the Jackson County Sheriff’s Department, Putnam County Sheriff’s Department, Algood Police Department, Cookeville Police Department, Monterey Police Department, Pickett County Sheriff’s Department and White County Sheriff’s Department.
“This continues to be an ongoing battle with people defrauding TennCare for their drugs,” said Inspector General Deborah Y. Faulkner, who joined the Overton Sheriff’s Office in launching the roundup Friday morning.“This is a battle we will continue to fight we will prosecute anyone involved in TennCare fraud, including pharmacists.
“An incredible amount of hard work and persistence went into these arrests, on the part of many in the Overton County Sheriff’s Department who are just as committed to getting this out of their communities.”
In addition to Clark, 50 individuals were indicted, 22 of them on TennCare fraud charges and are being arrested over the weekend or are expected to turn themselves in to police.
TennCare fraud is a Class E felony carrying a sentence of up to two years in prison per charge. District Attorney General Pro Temproe Anthony Craighead and Assistant District Attorney Owen G. Burnett will be prosecuting the cases.
Medusa

Livingston, TN

#14 Oct 27, 2008
YOU WILL GET CAUGHT!!!!!!
NASHVILLE – Two people in East Tennessee are charged today in separate indictments accusing them of TennCare fraud.

The Office of Inspector General (OIG) today announced the arrest of Donna Renee Roberts, 36, of Sunbright in Morgan County. Her arrest was assisted by the Morgan County Sheriff’s Department and the Department of Human Services. She’s accused of theft of services over $10,000, one count of TennCare fraud and four counts of food stamp fraud - all felonies - for failing to report her accurate income to the state, which would have made her ineligible for TennCare or food stamp services. If convicted, Roberts could be sentenced to up to six years on the charges, which are Class C and E felonies. Morgan County District Attorney Russell Johnson is prosecuting the case.

In a separate case in nearby Putnam County, 36-year old Pamela Dailey of Cookeville was indicted for TennCare fraud for allegedly making false statements about her marital status and failing to disclose her husband’s income so she would appear eligible for TennCare. The indictment says Dailey received more than $16,000 in medical benefits from the state program that she was not entitled to. Her bond was set at $2,500. If convicted, she could be sentenced to up to two years on the TennCare fraud charge. Acting District Attorney General Anthony J. Craighead is prosecuting.

“It’s a simple message that we are carrying across the state - if you lie, cheat or steal to get TennCare benefits, you stand a very likely chance of being charged and possibly serving jail or prison time, and even paying the state back for services received,” Inspector General Deborah Y. Faulkner said.“We’re bringing charges every week to people accused of TennCare fraud across Tennessee.”
Wake Up

Jamestown, TN

#15 Oct 28, 2008
Okay just wondering why it is that everyone that got caught and went to court and I quote "received a ________year sentence SUSPENDED to _________ years supervised probation." I have never understood why it is that the courts give a sentence and turn around in the same breathe and suspend it to probation. Some of the names above are well known. I went to school with a few of them and they were like that 20 years ago. Maybe if the courts would stop patting these crimmals on the back then some of this would stop. If you ask me, the courts are fining these crimmals, which they know don't have that kind of money with the threat of jail if their fines aren't paid. Well how do you think they are going get that money? And the courts know that and don't really care because nine times outta ten, it's going in their pockets!
IF YOU DO THE CRIME YOU SHOULD DO THE TIME!
lady in the hills

Jamestown, TN

#16 Oct 28, 2008
Wake Up wrote:
Okay just wondering why it is that everyone that got caught and went to court and I quote "received a ________year sentence SUSPENDED to _________ years supervised probation." I have never understood why it is that the courts give a sentence and turn around in the same breathe and suspend it to probation. Some of the names above are well known. I went to school with a few of them and they were like that 20 years ago. Maybe if the courts would stop patting these crimmals on the back then some of this would stop. If you ask me, the courts are fining these crimmals, which they know don't have that kind of money with the threat of jail if their fines aren't paid. Well how do you think they are going get that money? And the courts know that and don't really care because nine times outta ten, it's going in their pockets!
IF YOU DO THE CRIME YOU SHOULD DO THE TIME!
I agree, they should do the time! When are they going to start inditing the doctors that dispense drugs like candy? We all know at least one or two. Some may know more.
opinion

Jamestown, TN

#17 Oct 28, 2008
Most of the waste in TennCare, is Gross overpayment for patient transportation.(Fraud). Why is this never investigated?
frustrated

Livingston, TN

#18 Oct 31, 2008
Medusa wrote:
The Office of Inspector General (OIG) today announced the arrest of David G. Davis, 42, and Daniel R. Huddleston, 27, both of Byrdstown. The arrests are the result of a joint effort with the Pickett County Sheriff’s Office.
Both Davis and Huddleston were arrested on separate indictments for fraudulently obtaining prescription drugs using TennCare. TennCare paid for Davis’ transportation to and from his provider to obtain a prescription for Hydrocodone; Huddleston used TennCare to pay for both his prescription of Oxycodone and the provider visit. After obtaining the prescriptions, Davis and Huddleston resold a portion of the pills to an undercover agent.
“People who use TennCare in any way to access prescription drugs for resale can be prosecuted for TennCare fraud,” Inspector General Deborah Y. Faulkner said.“Prescription drug abuse is a problem all communities in Tennessee are working to eliminate.”
This was the second time that these two has got busted this year and they are still walking free. I seen one of them tonight as a matter of fact. No one ever gets time for selling drugs, but if they was to kill an animal they would get plenty of jail time then.
Vanessa

United States

#19 Sep 9, 2013
Let Leslie go!

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