The Best Ever

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Medicaid can be considered the best health care plan that ever existed for people with low income and few assets. The government program provides coverage for myriad health problems, and beneficiaries don’t have to pay anything to receive medical treatment. Perhaps that’s why the woman in today’s ”Fraud of the Day” was intent on taking advantage of the program’s generous benefits administered through her home state of Tennessee. (Who wouldn’t like to receive nearly $17,000 in free health care?)

Tennessee’s Medicaid program—TennCare—provides health care for an estimated 1.3 million residents who are primarily low-income pregnant women, children, elderly or disabled. It is the only program in the United States that enrolls the entire state’s Medicaid population in managed care.

The story states that the defendant at the center of this case falsely reported her income in order to qualify for TennCare benefits. The 36-year-old got lucky and received four years of judicial diversion—a program for first-time offenders that eliminates jail time and destroys records of the offense after the probation period is successfully completed. However, she will have to pay restitution to the state in the amount of $16,775.82

Congratulations to the Office of Inspector General which has been in operation since 2005, investigating cases involving more than $3 million in repayments to the TennCare program and the avoidance of more than $163.3 million in costs. According to the article, this woman is one of 2,664 people that have been charged with TennCare fraud to date. (While this woman may have thought she could receive health care benefits for free, it turns out that the investigators in this case are the best at outsmarting attempts by fraudsters to steal from the nation’s most vulnerable citizens.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Williamson County Woman Must Repay State After Pleading Guilty to TennCare Fraud,” published by The Chattanoogan.com on July 6, 2016.

A Williamson County woman charged with TennCare fraud must repay the state for benefits received through the healthcare insurance program.

The Office of Inspector General (OIG) on Wednesday announced that 36-year-old Ryanne N. Cunningham of Nolensville was ordered to make restitution to TennCare in the amount of $16,775.82 after she pleaded guilty to TennCare fraud and theft of services. She also received four years judicial diversion in exchange for her plea.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.