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Knox County Woman Charged with TennCare Fraud

Tuesday, May 18, 2021 | 03:13pm
Donna Pinkerton

NASHVILLE – A Knox County woman is charged with TennCare fraud for allegedly falsifying information in order to obtain TennCare healthcare insurance benefits.

The Office of Inspector General (OIG), in a joint effort with the Knoxville Police Department, today announced the arrest of 58-year old Donna Pinkerton, currently of Knoxville. She is charged with TennCare fraud, a class D felony and theft of services over $10,000 but under $60,000, which is a class C felony.

“The Division of TennCare does an excellent job providing Medicaid benefits for those rightfully qualifying in Tennessee,” Inspector General Kim Harmon said. “It is the duty of the Office of Inspector General to protect those benefits by identifying and investigating TennCare fraud.” 

OIG investigators allege that Pinkerton falsely reported that she had custody of her grandchild in order to receive TennCare benefits for herself, which resulted in TennCare’s payment of approximately $57,144 in fees and claims.  

The case is being prosecuted by District Attorney General Charme P. Allen of Knox County.

The OIG, which is separate from TennCare, began full operation in February of 2005 and has investigated over 5,760 criminal cases leading to more than $10.8 million dollars being repaid to TennCare, with a total estimated cost avoidance of more than $163.6 million dollars for TennCare, according to latest figures. TennCare’s budget is comprised of both federal and state dollars, 65% and 35% respectfully. To date, 3,115 people have been charged with TennCare fraud.

The OIG’s most wanted for TennCare fraud are posted online at https://www.tn.gov/finance/fa-oig/fa-oig-most-wanted.html. 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.”