Montgomery County Woman Charged with TennCare Fraud

NASHVILLE – A Montgomery County woman is accused of lying to the state in order to obtain health care insurance benefits through TennCare.

 

The Office of Inspector General (OIG) and the Montgomery County Sheriff’s Office today announced the arrest of Rufina Santos, 27, of Clarksville. 

 

Santos is accused in an indictment of one count of TennCare fraud and one count of theft of services. The indictment alleges Santos received medical services she wasn’t eligible for – because she failed to report her correct income to get enrolled in TennCare.

 

“People who misrepresent their income to qualify for TennCare are going to be caught and prosecuted,” Inspector General Deborah Y. Faulkner said.  “By catching people who are illegally on the program, we are preserving TennCare for people who really qualify for the program.”

 

If convicted, Santos could be sentenced to up to four years on the class D felony theft of services charge, and two years on class E felony TennCare fraud charge. District Attorney General John W. Carney will prosecute.

 

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 $159 million for the TennCare program, according to latest figures.  To date, over 900 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.tncarefraud.tennessee.gov and follow the prompts that read "Report TennCare Fraud."