Alabama Woman Charged with TennCare Fraud

NASHVILLE, TN – A Florence, Alabama, woman is charged with TennCare fraud for claiming to live in Tennessee in order to obtain TennCare healthcare insurance benefits.

The Office of Inspector General (OIG), with assistance from the Wayne County Sheriff’s Office, today announced the arrest of Melissa Burns, 38, of Florence, Alabama.

A Wayne County Grand Jury charged Burns with three counts of TennCare fraud and two counts of theft of services.  An indictment charges her with unlawfully and intentionally obtaining medical benefits for herself, her spouse and her minor children by intentionally misrepresenting that the family resided in Tennessee.  They actually lived in the State of Alabama, which rendered them ineligible for TennCare Medicaid services.

“People who live in another state and claim to live in Tennessee in order to get healthcare benefits are going to be caught, plain and simple,” Inspector General Deborah Faulkner said. “When Tennesseans hear about anyone crossing state lines to enroll in TennCare, we need to know about it.”

Theft of Services over $10,000 is a Class C felony that carries a maximum of six years in prison. Theft of Services over $1,000 is a Class D felony that carries a maximum of four years in prison.  Illegally obtaining TennCare medical benefits is a Class E felony that carries a maximum penalty of two years in prison.   District Attorney General Mike Bottoms will prosecute.

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, 2,100 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."