TennCare Fraud Cases Decline In April, But Still Higher Than Average
Published May 3, 2021
The Tennessee Conservative Staff –
The number of reported TennCare fraud cases declined in April down to just three for the month from a recent high number of 6 cases in March.
Despite the drop by half for April, the number is still high considering only one reported case 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.
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.
In April’s first case, a Unicoi County man was charged in Washington County with six counts of TennCare fraud for allegedly doctor shopping for prescriptions for drugs.
The Office of Inspector General (OIG), in a joint effort with the Tennessee Highway Patrol and the Washington County Sheriff’s Office, announced that 39-year old Barry Osbourne was charged with six counts of TennCare fraud, a Class D felony.
The charges accuse Osbourne of visiting multiple physicians in a short period of time to obtain medications for pain, without disclosing to the doctors that he had obtained another similar prescription recently from a different doctor.
“With the help of local law enforcement communities, Tennessee has emphasized a concerted effort to prevent doctor shopping and fight the scourge of opioid abuse,” Inspector General Kim Harmon said. “Together we work to keep prescription drugs from being diverted to the streets of our hometowns.”
The case is being prosecuted by District Attorney General Ken C. Baldwin of Washington County.
The other two cases in April both involved individuals from out-of-state.
In the 2nd case for the month of April, a woman in Aurora, Illinois was charged with TennCare fraud for allegedly claiming to live in Tennessee to obtain benefits through the state’s healthcare insurance program.
In conjunction with sheriff’s officers in Montgomery County, Tennessee and Kane County, Illinois, the Office of the Inspector General announced the arrest of 46-year old Michelle Weinert.
She was charged with TennCare fraud (a class D felony) and theft of services, a class C felony.
Investigators say Weinert was residing in Illinois and falsely reporting a Tennessee residence to remain on TennCare.
As a result, TennCare paid more than $14,000.00 in fees and claims on behalf of Weinert and her son.
Sheriff’s officers in Illinois were persistent in pursuing Weinert, who had been placed on the OIG’s “Most Wanted” list because of the difficulty in locating her.
“We truly value our partners in local law enforcement not only in Tennessee but in areas outside our state where partnering with us is crucial to our mission,” Inspector General Kim Harmon said. “The OIG works to strengthen these relationships inside our borders and beyond to ensure that those who choose to abuse TennCare are brought to justice.”
The case is being prosecuted by District Attorney General John W. Carney, Jr. of Montgomery County.
And in the third and final reported case for April, an Alabama woman was also charged TennCare fraud and theft of services for allegedly reporting false information to the state to obtain TennCare healthcare insurance benefits.
The Office of Inspector General, in a combined effort with sheriff’s offices in Lawrence County, Alabama and Marshall County, Tennessee arrested 33-year old Jessica Skinner, who is currently a resident of Town Creek, Alabama.
She was charged with TennCare fraud, a class D felony and theft of property over $10,000 but under $60,000, a class C felony.
Investigators allege that for a three-year period, Skinner reported that she had custody of her children in addition to falsely reporting that she resided in Tennessee.
These factors made her eligible for TennCare and as a result TennCare paid approximately $56,900.00 in fees and claims on her behalf.
“Our law enforcement partners, both in and outside Tennessee, are critical to our mission,” Inspector General Kim Harmon said. “By partnering with both Lawrence County, Alabama and Marshall County, Tennessee sheriff’s offices, we were able to apprehend one of our ‘Most Wanted’ subjects.”
The case is being prosecuted by District Attorney General Robert J. Carter of Marshall County.
The OIG, which is separate from TennCare, began full operation in February 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, 3,113 people have been charged with TennCare fraud.
The OIG’s most wanted for TennCare fraud are posted online here.
Anyone with information about their whereabouts 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.”
