Sevier County Woman Must Repay State After TennCare Fraud Conviction

NASHVILLE – A Sevier County woman accused of TennCare fraud has pleaded guilty to charges in Sevierville.

The Office of Inspector General (OIG) today announced that Amy Jo Smith, 34, must repay the state for $24,386.95 in TennCare benefits received while she was fraudulently enrolled in the program.

Smith was charged in May of 2006 of making false statements to the state that she and her husband were divorcing and no longer living in the same household, in order to retain her TennCare medical benefits.  Smith had falsely stated on her application that she did not have access to private health insurance coverage when she had been offered health insurance through her husband’s employer and declined.  Smith had obtained hospital care, physician and pharmacy services using TennnCare she received because of her misrepresentation.

“TennCare serves people who are eligible for the program – mostly those who are poor, disabled or very ill – and we intend to pursue anyone who misrepresents themselves in order to access benefits through TennCare,” Inspector General Deborah Y. Faulkner said.  

Smith pleaded guilty to two counts of TennCare fraud and one count of theft of services. She received a suspended sentence of six years, and must report to a probation officer during that time, on the condition that she repays TennCare for the benefits used while she was enrolled. District Attorney General Randall Nichols prosecuted this case.

The OIG, which is separate from TennCare, began full operation in February 2005 and has investigated cases leading to over $2.6 million paid in restitution and recoupment to TennCare, with a total estimated cost avoidance of over $165 million for the TennCare program, according to latest figures.  To date, over 920 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."