Wilson woman charged in plot to defraud TennCare

Staff Reports • Dec 17, 2015 at 6:43 PM

A Wilson County woman was charged Thursday in Trousdale County with TennCare fraud in connection with taking over a relative’s assets so the state would pay for the relative’s nursing home care.

The Office of Inspector General, with the assistance of the Trousdale County Sheriff’s Office, charged Angela Douglas, 45, of Mt. Juliet.

In a three-count indictment, Douglas was accused of transferring her grandfather’s assets and resources to herself, using power of attorney, in order to make him eligible for TennCare benefits, which would include nursing home care. She’s charged with two counts of TennCare fraud and one count of theft of services.

"TennCare provides specialized care for low-income people who are truly eligible and need assistance - people who have few or no assets," said Acting Inspector General Robert White. "Many people want to preserve their assets for children or other beneficiaries, but federal law prohibits this kind of pauperizing of a person to trigger government aid for expensive long-term care."

While the Medicaid portion of TennCare provides medical assistance to low-income people who need long-term care, those who apply must disclose assets or certain transfers of assets that happened during the five years prior to applying for Medicaid.

Illegally obtaining TennCare medical benefits is a Class E felony that carries a maximum penalty of two years in prison per charge. Theft of services of more than $10,000 is a Class C felony that carries a maximum sentence of six years in prison. District Attorney General Tommy Thompson will serve as prosecutor.

The OIG, which is separate from TennCare, began full operation in February 2005 and has investigated cases leading to more than $3.5 million paid in restitution and recoupment to TennCare, with a total estimated cost avoidance of more than $173 million for the TennCare program, according to latest figures. To date, 2,133 people were 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 800-433-3982 toll-free from anywhere in Tennessee, or log on to tn.gov/tnoig and follow the prompts that read "Report TennCare Fraud."

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