KNOX, SEVIER COUNTY RESIDENTS CHARGED WITH TENNCARE FRAUD

NASHVILLE – Two East Tennesseans have been charged with TennCare fraud.

The Office of Inspector General (OIG) today announced that a Sevier County woman is accused of intentionally misrepresenting herself to gain TennCare benefits, and in a separate case, a Knox County woman is charged with prescription drug fraud.

Governor Phil Bredesen created the Office of Inspector General, one of the first units of its kind in the nation, in 2004. Since it became operational in February 2005, 250 people have been charged with TennCare fraud.

31-year-old Amy Jo Smith of Sevier County is accused of making false statements to the Department of Human Services claiming she and her husband were divorcing and no longer living in the same household, in order to retain her TennCare medical benefits.  The indictment against Smith says she also unlawfully and feloniously obtained medical benefits by falsely stating on her application that she did not have access to private health insurance coverage.  The indictment says smith had been offered – and declined – health insurance coverage through her husband’s employer. Finally, the indictment accuses smith of knowingly obtaining hospital care, physician and pharmacy services and supplies and other medical treatment by deception, fraud, coercion, false pretense and fraudulent enrollment in TennCare.  The Sevier County Sheriff’s Office assisted with the arrest.

“This case came to us through our Web page that allows the public to report suspected TennCare fraud,” Inspector General Deborah Faulkner said. “It’s a great example of a citizen helping us in the war against TennCare fraud.”

If convicted, Smith could face up to 6 years in prison on the class C and E felonies lodged against her.   District Attorney Al C. Schmutzer, Jr., will prosecute.

In an unrelated case, 25-year old Kristen LeAnn Spires of Knoxville is accused ot trying to obtain controlled substances by fraud. Knox County indictments accuse Spires of knowingly obtaining controlled substances by misrepresentation, fraud, forgery and deception. Spires is accused of presenting local pharmacies with forged prescriptions that were paid for by TennCare.

The class E fraud charge against Spires carries a penalty of up to two-years in prison. The class D controlled substance charge carries a penalty of up to four years in prison. Spires’ bond is set at $7,000.00. District Attorney Randy Nichols is prosecuting.