Tennessee Medicaid pursues felony charges against some members : Shots


LaShonia Ingram was considered one of 28 Medicaid beneficiaries in Tennessee charged with TennCare fraud final yr. The District Lawyer dropped the felony costs.

Brad Vest/WPLN

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Brad Vest/WPLN

LaShonia Ingram was considered one of 28 Medicaid beneficiaries in Tennessee charged with TennCare fraud final yr. The District Lawyer dropped the felony costs.

Brad Vest/WPLN

Life was upended for LaShonia Ingram over the past yr, and a shadow nonetheless follows her round.

Search her title on-line, and the primary outcome contains the phrases “fraud” and “most wished.”

“It was horrible. I could not get a job,” says the 42-year-old mom from Memphis, Tennessee. “All doorways have been being closed in my face.”

Ingram resorted to promoting purses out of her trunk to help her household. She says even DoorDash and Uber would not permit her to work with a felony cost.

Her alleged crime? Fraud.

The state of Tennessee accused her of residing in close by Horn Lake, Mississippi, whereas nonetheless being enrolled within the state’s Medicaid program, referred to as TennCare. All of it turned out to be a mix-up, however the harm to her repute and funds was carried out.

Tennessee is without doubt one of the most aggressive states within the nation relating to policing doable Medicaid fraud amongst beneficiaries like Ingram. The state posts the names and images of individuals arrested for alleged fraud on a authorities web site and social media. Some even wind up on a so-called “most wished” record, as in the event that they have been harmful and on the run.

The record is maintained by Tennessee’s Workplace of Inspector Common. The workplace was launched in 2005 when many of the instances concerned drug diversion: individuals have been accused of utilizing TennCare advantages to accumulate large portions of narcotics to promote on the road. However as federal guidelines have slowed the unlawful prescription drug market, arrests associated to Medicaid are as an alternative sweeping up individuals accused of transferring out of state — usually throughout the similar group — with out canceling their advantages.

An obvious clerical error results in an arrest

Ingram was considered one of 28 Medicaid beneficiaries in Tennessee charged in 2022, in accordance with the Tennessee OIG; greater than a 3rd of them have been accused of not being a Tennessee resident, with many instances originating within the Memphis space the place a few of the suburbs are in Mississippi.

In Ingram’s case, Tennessee introduced her arrest in a press launch, saying she “eluded” authorities for practically a yr. Ingram says she did not have a clue concerning the costs till she obtained a ticket for not carrying her seatbelt.

“They pulled me over, they usually mentioned, ‘you’ve a felony warrant.’ And I mentioned, ‘give up mendacity,'” she remembers. “I’ve by no means been in bother a day in my life.”

It took $2,000 to bond out of jail and much more to rent an lawyer. Not till greater than six months later did prosecutors present her the proof so she might refute the costs and clear her title.

The reason ended up being fairly easy. Throughout the time she was on Tennessee’s Medicaid program and residing in Memphis, she filed for divorce from her husband who lived close by in Mississippi. She says they’d been separated for years, however her driver’s license nonetheless had the outdated Mississippi deal with.

After her arrest, Ingram confirmed her Tennessee lease and electrical payments, and the Shelby County District Lawyer dropped the felony costs.

Most states concentrate on well being care supplier fraud

Each state has an workplace to analyze Medicaid fraud dedicated by docs and different well being care suppliers, since that is often the place essentially the most cash could be recovered. Not as many crack down on sufferers like Tennessee does.

“We attempt to apply the regulation compassionately,” Chad Holman, who leads the TennCare OIG, advised NPR.

Another states do have patient-focused items, however they do not essentially title the accused publicly. For instance, South Carolina retains them nameless even after they’ve agreed to reimburse the state.

Holman defends Tennessee’s apply of posting a “most wished” record for its Medicaid program. He says it is presupposed to be a deterrent: “It is to not blast anybody or defame anybody. It is to easily care for the enterprise that is at hand, maintain individuals accountable and do what we’re right here to do,” he says.

As drug-related instances have diminished, enforcement has more and more targeted on guaranteeing that individuals enrolled in TennCare reside within the state. In Memphis, 20 of the 27 Medicaid fraud instances since 2019 concerned questions of state residency, in accordance with the Shelby County District Lawyer. And prosecutors have dropped no less than a half dozen of these instances as a result of the proof was so weak.

Holman says his workplace will not overlook low-level offenses.

“This isn’t homicide,” he says. “However the legislature categorised it as a felony, and that is the regulation that I am right here to implement.”

However enforcement is pricey. And Holman acknowledges it prices way more to run the TennCare fraud unit than the workplace will ever recoup from individuals on Medicaid, who’re often low-income to start out with. Even when the state recovered each greenback from costs introduced towards beneficiaries in 2022, the full would quantity to lower than $900,000. The workplace has a funds of $6.4 million a yr. Since its creation in 2005, the OIG has introduced in lower than $10 million and charged practically 3,200 individuals with fraud, in accordance with its personal press releases.

And the speed of arrests has slowed dramatically. It now arrests fewer individuals in a yr than it beforehand did in a single month.

A Medicaid ‘cliff’ is coming

At this level, about one in 4 People is on Medicaid or CHIP — the Kids’s Well being Insurance coverage Program. The variety of individuals enrolled elevated by greater than 20 million since early 2020. And for the primary time for the reason that begin of the pandemic, states are going to be verifying revenue and addresses over the following yr. Million of People might lose their Medicaid protection consequently. It is as much as every state to find out who’s eligible and the right way to take care of potential fraud in this system.

Michele Johnson, government director of the Tennessee Justice Heart, says policing fraud amongst TennCare beneficiaries takes money and time that might be spent on one thing extra useful.

“It might be nice if our leaders would get out of the gotcha recreation and get into the getting individuals wholesome recreation,” she says.

Particularly now, as Medicaid applications are restarting checks on eligibility, Johnson says recipients should not have to fret {that a} mistake might finally get them arrested.

Regardless of the ordeal she went by means of, Ingram is bouncing again. Nonetheless, she has authorized payments to pay and has grown extra annoyed at being ensnared by the state’s Medicaid dragnet.

“They made an enormous mistake,” she says.

This story was produced in partnership with Nashville Public Radio and Kaiser Well being Information.