A Hamilton County woman is 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, in a joint effort with the Hamilton County Sheriff’s office, Monday announced the arrest of Mary Gould, 43. She’s 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.
The OIG, which is separate from TennCare, began full operation in February 2005 and has investigated more than 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. TennCare’s budget is comprised of both federal and state dollars, 65 percent and 35 percent respectfully. To date, 3,124 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.”