Wilson County Man Charged with TennCare Fraud

Thursday, March 31, 2022 | 03:13pm
TennCare fraud mug shot

NASHVILLE –  A Wilson County man faces nearly a dozen criminal charges including TennCare fraud after investigators allege he withheld information from the state so he could appear to be eligible for the state’s healthcare insurance program.

The Office of Inspector General (OIG) today announced the arrest of 36-year-old Gezim Kolshi, charged with one count each of TennCare fraud and theft of services along with four counts of destruction and tampering with government records and five counts related to the personal commercial computer act of 2003. Investigators say Kolshi failed to report his true income so he could receive TennCare benefits that he was otherwise not eligible to receive. As a result, TennCare paid more than $25,701 in fees and claims on behalf Kolshi and his family.  

“As this case exhibits, the investigative reach of the OIG can include a vast array of charges, so long as they were committed in conjunction with the TennCare Fraud investigation.” Inspector General Chad Holman said. “We focus on the entirety of the criminal conduct that is committed against the TennCare system to protect the system for those who are truly eligible for and desperately need the benefits that TennCare offers.” 

TennCare fraud is a class D felony and theft of services is a class C felony. Destruction and tampering with government records is a class E felony and the computer act charges are class C felonies. The case is being prosecuted by District Attorney General Jason L. Lawson who serves Jackson, Macon, Smith, Trousdale and Wilson counties.

The OIG, which is separate from TennCare, began full operation in February 2005 and has identified and investigated more than 130,349 potential fraud cases leading to more than $9.2 million being repaid to TennCare.  In the last year ending June 30, 2021 total estimated cost avoidance was more than $7.5 million. TennCare's budget is comprised of 65 percent federal and 35 percent state dollars. To date, 3,160 people of been charged with TennCare fraud.

The OIG’s “Most Wanted” list can be located online at 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.”