Department of Finance & Administration
Mark Emkes, Commissioner

SHELBY COUNTY WOMAN MUST REPAY TENNCARE AFTER PLEADING GUILTY TO FRAUD

NASHVILLE – A Shelby County woman has been ordered to repay the state over $20,000 after it was found she received pharmacy and medical benefits she wasn’t eligible for through the TennCare public healthcare insurance program.

The Office of Inspector General (OIG) today announced the sentence given to 38-year old Zandra Smith of Memphis, who pleaded guilty to one count of TennCare fraud.  She received two years judicial diversion and she must repay TennCare $22,146.90 for benefits paid on her behalf to pharmacies and healthcare providers.

“TennCare is an important program for people who are eligible – and to maintain the program for people who need it, we have to pursue those who try to take from a program they do not qualify for,” Inspector General Deborah Y. Faulkner said. “We are aggressively pursuing and prosecuting these and other TennCare fraud cases all across the state of Tennessee.”

Smith was indicted on April 13, 2011, on the felony TennCare fraud charge for underreporting her income – which would have made her ineligible for TennCare.  District Attorney Amy T. Weirich prosecuted this case.

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, nearly 1,500 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 1-800-433-3982 toll-free from anywhere in Tennessee, or log on to www.tn.gov/tnoig and follow the prompts that read "Report TennCare Fraud."