Georgia Woman Charged With TennCare Fraud

Wednesday, July 9, 2014

A Georgia woman is charged with claiming she lived in Tennessee in order to obtain TennCare health care insurance benefits.

The Office of Inspector General (OIG) on Wednesday announced the arrest of Xochitl Gomez, 47, of Rossville. She surrendered at the Hamilton County Sheriff’s Office.

Ms. Gomez is charged in an indictment with TennCare fraud and theft of property.  The indictment accuses her of falsely reporting to the state that she and her children resided in Tennessee, in order to be eligible for TennCare benefits, when they actually live in Rossville.

“Anyone who misrepresents their income, address, employment or other information to gain TennCare benefits will be prosecuted,” acting Inspector General Robert White said. “Tennessee taxpayers clearly want to keep people out of the program who are not eligible, and who would commit fraud to illegally gain healthcare insurance benefits.”

The TennCare fraud charge against Ms. Gomez could result in a two-year sentence, if she is convicted.   Theft of property over $10,000 is a Class C felony that carries a maximum sentence of six years in prison.  District Attorney General William H. Cox III, is prosecuting.

The OIG, which is separate from TennCare, began full operation in February 2005, and has investigated cases leading to over $3.5 million paid in restitution and recoupment to TennCare, with a total estimated cost avoidance of over $173 million for the TennCare program, according to latest figures.  To date, 2,138 people have been charged with TennCare fraud.

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 800 433-3982 toll-free from anywhere in Tennessee, or log on to www.tn.gov/tnoig/ and follow the prompts that read "Report TennCare Fraud."



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