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Humphreys County Woman Charged with TennCare Fraud

Friday, December 21, 2012 | 05:02am

NASHVILLE, TN – A Humphreys County woman is charged with TennCare fraud and theft of services after she received healthcare insurance benefits through TennCare, even though she was not eligible for the program.

The Office of Inspector General (OIG) today announced the arrest of Lisa A. Herlein, 39, of McEwen. She is charged with two counts of TennCare fraud and one count of theft of services.

Herlein is accused of concealing material facts in order to appear eligible for TennCare, which otherwise she would not have qualified to receive. Charges also accuse her of making factitious statements during the investigation.  In addition, Herlein has been charged with theft of services for knowingly and feloniously obtaining services by deception, fraud, coercion, false pretense or by other means to avoid payment for services.

“People who misrepresent something about their current situation in order to qualify for TennCare are going to be caught and prosecuted,” Inspector General Deborah Y. Faulkner said. “TennCare fraud is a felony, and a conviction could mean jail time, paying the state back for any medical services received, and even losing the right to apply for TennCare benefits, even for those who qualify.”

The TennCare fraud charge carries up to a two-year sentence, and the theft of services charge could result in a sentence up to six years. District Attorney General Dan M. Alsobrooks is prosecuting.

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, over 1,700 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."

TennCare Fraud | Press Releases