TennCare Fraud Cases Again On The Rise After Recent Decline

Published July 12, 2021

The Tennessee Conservative [By Jason Vaughn] –

The number of TennCare fraud cases For May and June stand at 6 cases per month, which match the highest number of the year so far, set in March

Tennessee Capitol Building in Nashville

In April, the number of cases was only 3 but still higher than this year’s average to that point with only one case reported in February and another single case reported in January. 

Recipients of TennCare hold a high satisfaction rate with the services according to a February study conducted by the Boyd Center for Business and Economic Research at the University of Tennessee, Knoxville.  

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The satisfaction rate holds steady at 94 percent, marking the 12th straight year above 90 percent.  

That, and the free price tag of the services for anyone below the poverty line, goes a long way toward explaining why many seek to take advantage of the taxpayer-funded program.  

TennCare is funded with approximately 65% federal and 35% state tax dollars.   

TennCare Fraud cases for June 2021: 

Announced June 22nd, A McNairy County woman was charged with TennCare fraud and theft of services in connection with allegedly giving the state false information to appear eligible for TennCare.   

The Office of Inspector General (OIG) arrested 58-year old Melissa Howard.  

She was charged with one count each of TennCare fraud, which is a class D felony, and theft of property between $10,000.00 and $60,000.00. a class C felony. She’s accused of reporting she had custody of a minor, resulting in the payment of approximately $15,000 in health care benefits from TennCare on her behalf. 

Inspector General Kim Harmon said, “If an individual is not qualified for TennCare benefits, they are not entitled to have TennCare pay for their medical bills and pharmacy claims.  The Office of Inspector General strives to protect our taxpayer’s hard-earned money and ensure that those who choose to commit fraud are brought to justice.” 

The case is being prosecuted by District Attorney General Mark E. Davidson of McNairy County

Announced June 21st,  a Hamilton County woman was charged with TennCare fraud and theft of services in connection with allegedly falsely reporting a Tennessee residence to obtain TennCare healthcare insurance benefits.   

The Office of Inspector General (OIG), in a joint effort with the Hamilton County Sheriff’s office, arrested 43-year old Mary Gould.  

She was charged with TennCare fraud, which is a class D felony and theft of services over $10,0000 but under $60,000, a class C felony. 

Investigators allege that Gould was residing in Georgia when she reported a Tennessee address to the state, resulting in TennCare paying more than $19,000 in fees and claims on her behalf. Gould has since moved back to Tennessee. 

“The TennCare program is designed to help those who rightfully qualify for benefits,” Inspector General Kim Harmon said. “OIG strives to ensure that those taking undue advantage of Tennessee’s Medicaid program are asked to answer for their actions.” 

The case is being prosecuted by District Attorney General Neal Pinkston of Hamilton County. 

Announced June 18, A Fentress County man was charged with TennCare fraud involving the alleged resale of prescription drugs obtained using TennCare healthcare insurance benefits.    

The Office of Inspector General (OIG) announced the arrest of Kenny Evans of Pall Mall, Tennessee, in a joint effort with the Fentress County Sheriff’s Department.  

Evans is charged with one count of knowingly selling drugs he obtained through TennCare benefits and TennCare fraud.  Investigators say Evans used TennCare to obtain Oxycodone tablets, then sold a portion to an undercover informant.   

“One of the Office of Inspector General’s missions is to prevent people from using their TennCare benefits to sell drugs on the streets of our Tennessee communities,” Inspector Kim Harmon said. “We strive to ensure that our taxpayer’s money is being used properly and that people such as Mr. Evans are held accountable for their actions.” 

The case is being prosecuted by District Attorney General Jared R. Effler

On June 14th, it was announced that an Alabama woman is ordered to repay the state after conviction for TennCare fraud and theft of property. 

Jessica Dean Skinner, 33, is ordered to repay the state $56,921.33 and she’ll be on probation for ten years.  

Skinner was charged in April of this year in Marshall County with falsely reporting she lived in Tennessee when she was residing in Alabama. She was also charged for falsely reporting she had custody of her children in order to appear eligible for TennCare. The case was prosecuted by District Attorney General Robert J. Carter of Marshall County. 

“We appreciate the perseverance of the Marshall County District Attorney General’s Office in bringing prosecution of TennCare fraud to the forefront in their local communities,” Inspector General Kim Harmon said. “Our office will continue to do our part and preserve the integrity of TennCare benefits, so that those truly deserving of and eligible for TennCare have the best resources.” 

On June 7th, it was announced that a man in Overton County was charged with TennCare fraud and theft of services for allegedly failing to report substantial property when applying for state and federal healthcare insurance benefits through TennCare and Medicare.   

The Office of Inspector General (OIG), in a joint effort with the Overton County Sheriff’s Office, arrested Joseph Jones, 68, of Hilham, Tennessee which is near Livingston. He is charged with TennCare fraud, which is a class D felony and theft of services over $10,000 but under $60,000, a class C felony.    

Investigators allege that Jones fraudulently failed to disclose all his assets and resources in his joint application for Medicare and Medicaid and as a result TennCare paid more than $13,894 on Jones’s behalf. 

“The intentional omission of assets on an application for public health insurance benefits is a crime and will not be tolerated in Tennessee,” Inspector General Kim Harmon said. “The Office of Inspector General, in partnership with local law enforcement, works diligently to preserve these benefits for those rightfully qualified.”  

The case is being prosecuted by District Attorney General Bryant C. Dunaway of Overton County. 

On June 3rd, it was announced that two people living in Robertson County in middle Tennessee were charged with TennCare fraud in connection with allegedly giving the state false information to obtain healthcare insurance benefits through TennCare. 

The Office of Inspector General (OIG), working with the Robertson County Sheriff’s Office, announced that 46-year old Talina Cole and her estranged husband, 43-year old Johnny Cole are each charged with TennCare fraud and theft of services over $10,000 but under $60,000. 

Investigators alleged that Johnny Cole under-reported his income, resulting in TennCare paying approximately $16,679 on his behalf.  Talina Cole’s charges also relate to allegedly submitting false information and TennCare paid more than $23,077 on her behalf even though she was not actually eligible for TennCare. 

“Intentionally providing false information regarding one’s income, or custody of a child, in order to take undue advantage of TennCare is a crime in Tennessee,” Inspector General Kim Harmon said. “The Office of Inspector General works diligently to preserve these benefits for those rightfully qualified.”  

Theft of services in these cases are class C felonies; and, TennCare fraud is a class D felony.  

The case is being prosecuted by District Attorney General John W. Carney, Jr. of Robertson County. 

The OIG, which is separate from TennCare, began full operation in February of 2005, and has investigated over 5,760 criminal cases leading to more than $10.8 million being repaid to TennCare, with a total estimated cost avoidance of more than $163.6 million for TennCare, according to latest figures.  

To date, 3,129 people have been charged with TennCare fraud. 

To access the OIG most wanted list, please visit https://www.tn.gov/finance/fa-oig/fa-oig-most-wanted.html. Anyone with information about a wanted subject is urged to use the contact information on the page.  

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, or by logging on to www.tn.gov/oig/ and following the prompts that read “Report TennCare Fraud.” 

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About the Author:

Jason Vaughn, Media Coordinator for The Tennessee Conservative 

Jason previously worked for a legacy publishing company based in Crossville, TN in a variety of roles through his career.  Most recently, he served as Deputy Directory for their flagship publication. Prior, he was a freelance journalist writing articles that appeared in the Herald Citizen, the Crossville Chronicle and The Oracle among others.  He graduated from Tennessee Technological University with a Bachelor’s in English-Journalism, with minors in Broadcast Journalism and History.  Contact Jason at news@TennesseeConservativeNews.com

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