Tennessee Medicaid pursues felony charges against some members : Shots

Tennessee Medicaid is pursuing felony charges against some members in an effort to prevent misuse and fraud in the program.

The Tennessee Department of Human Services (TDHS) recently announced that it has launched a new initiative to prevent fraud and misuse of Medicaid benefits. As part of this initiative, TDHS is now pursuing felony charges against members deemed to be misusing their benefits.

This initiative is intended to protect Medicaid resources and ensure that all members are treated fairly. State authorities plan to crack down on Medicaid fraud and misuse in the coming months, with felony charges being used as a deterrent against members who may be tempted to knowingly commit fraud or otherwise abuse the system.

The TDHS explained that it will investigate allegations of fraud and misuse of Medicaid benefits, and those found to have taken part in fraudulent or other criminal activities will face prosecution and possible criminal prosecution. Anyone convicted of a felony offense could face a lengthy prison sentence if found guilty.

Aside from the criminal justice penalties, those found to have engaged in fraud or misuse may also face civil monetary penalties and confiscation of property. The department also explained that in addition to the pursuit of criminal charges, it will also suspend the Medicaid benefits of those found to be misusing the program.

TDHS authorities stated that this new initiative is an important step in ensuring that all members of the Medicaid program are treated fairly and that resources are preserved for those who genuinely need them. The department also urged those who know of any suspicious activity or fraud to contact their local TDHS office and report it.

This new initiative from the TDHS is a sign of the agency’s dedication to issuing justice for those that abuse the system and misuse Medicaid resources. With felony charges now an option for those found to be misusing the system, hopefully this will act as a strong deterrent in the coming months.

LaShonia Ingram was one of 28 Medicaid beneficiaries in Tennessee charged with TennCare fraud last year. The District Attorney dropped the felony charges.

Brad Vest/WPLN

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Brad Vest/WPLN

LaShonia Ingram was one of 28 Medicaid beneficiaries in Tennessee charged with TennCare fraud last year. The District Attorney dropped the felony charges.

Brad Vest/WPLN

Life was upended for LaShonia Ingram over the last year, and a shadow still follows her around.

Search her name online, and the first result includes the words “fraud” and “most wanted.”

“It was horrible. I couldn’t get a job,” says the 42-year-old mother from Memphis, Tennessee. “All doors were being closed in my face.”

Ingram resorted to selling purses out of her trunk to support her family. She says even DoorDash and Uber wouldn’t allow her to work with a felony charge.

Her alleged crime? Fraud.

The state of Tennessee accused her of living in nearby Horn Lake, Mississippi, while still being enrolled in the state’s Medicaid program, known as TennCare. It all turned out to be a mix-up, but the damage to her reputation and finances was done.

Tennessee is one of the most aggressive states in the nation when it comes to policing possible Medicaid fraud among beneficiaries like Ingram. The state posts the names and photos of people arrested for alleged fraud on a government website and social media. Some even wind up on a so-called “most wanted” list, as if they were dangerous and on the run.

The list is maintained by Tennessee’s Office of Inspector General. The office was launched in 2005 when most of the cases involved drug diversion: people were accused of using TennCare benefits to acquire massive quantities of narcotics to sell on the street. But as federal rules have slowed the illegal prescription drug market, arrests related to Medicaid are instead sweeping up people accused of moving out of state — often within the same community — without canceling their benefits.

An apparent clerical error leads to an arrest

Ingram was one of 28 Medicaid beneficiaries in Tennessee charged in 2022, according to the Tennessee OIG; more than a third of them were accused of not being a Tennessee resident, with many cases originating in the Memphis area where some of the suburbs are in Mississippi.

In Ingram’s case, Tennessee announced her arrest in a press release, saying she “eluded” authorities for nearly a year. Ingram says she didn’t have a clue about the charges until she got a ticket for not wearing her seatbelt.

“They pulled me over, and they said, ‘you have a felony warrant.’ And I said, ‘quit lying,'” she recalls. “I’ve never been in trouble a day in my life.”

It took $2,000 to bond out of jail and even more to hire an attorney. Not until more than six months later did prosecutors show her the evidence so she could refute the charges and clear her name.

The explanation ended up being pretty straightforward. During the time she was on Tennessee’s Medicaid program and living in Memphis, she filed for divorce from her husband who lived nearby in Mississippi. She says they had been separated for years, but her driver’s license still had the outdated Mississippi address.

After her arrest, Ingram showed her Tennessee lease and electric bills, and the Shelby County District Attorney dropped the felony charges.

Most states focus on health care provider fraud

Every state has an office to investigate Medicaid fraud committed by doctors and other health care providers, since that’s usually where the most money can be recovered. Not as many crack down on patients like Tennessee does.

“We try to apply the law compassionately,” Chad Holman, who leads the TennCare OIG, told NPR.

Some other states do have patient-focused units, but they don’t necessarily name the accused publicly. For example, South Carolina keeps them anonymous even after they’ve agreed to reimburse the state.

Holman defends Tennessee’s practice of posting a “most wanted” list for its Medicaid program. He says it’s supposed to be a deterrent: “It’s not to blast anyone or defame anyone. It’s to simply take care of the business that’s at hand, hold people accountable and do what we’re here to do,” he says.

As drug-related cases have diminished, enforcement has increasingly focused on ensuring that people enrolled in TennCare live in the state. In Memphis, 20 of the 27 Medicaid fraud cases since 2019 involved questions of state residency, according to the Shelby County District Attorney. And prosecutors have dropped at least a half dozen of those cases because the evidence was so weak.

Holman says his office won’t overlook low-level offenses.

“This is not murder,” he says. “But the legislature classified it as a felony, and that’s the law that I’m here to enforce.”

But enforcement is expensive. And Holman acknowledges it costs far more to run the TennCare fraud unit than the office will ever recoup from people on Medicaid, who are usually low-income to start with. Even if the state recovered every dollar from charges brought against beneficiaries in 2022, the total would amount to less than $900,000. The office has a budget of $6.4 million a year. Since its creation in 2005, the OIG has brought in less than $10 million and charged nearly 3,200 people with fraud, according to its own press releases.

And the rate of arrests has slowed dramatically. It now arrests fewer people in a year than it previously did in a single month.

A Medicaid ‘cliff’ is coming

At this point, about one in four Americans is on Medicaid or CHIP — the Children’s Health Insurance Program. The number of people enrolled increased by more than 20 million since early 2020. And for the first time since the start of the pandemic, states are going to be verifying income and addresses over the next year. Million of Americans could lose their Medicaid coverage as a result. It’s up to each state to determine who is eligible and how to deal with potential fraud in the program.

Michele Johnson, executive director of the Tennessee Justice Center, says policing fraud among TennCare beneficiaries takes time and money that could be spent on something more helpful.

“It’d be great if our leaders would get out of the gotcha game and get into the getting people healthy game,” she says.

Especially now, as Medicaid programs are restarting checks on eligibility, Johnson says recipients shouldn’t have to worry that a mistake could eventually get them arrested.

Despite the ordeal she went through, Ingram is bouncing back. Still, she has legal bills to pay and has grown more frustrated at being ensnared by the state’s Medicaid dragnet.

“They made a big mistake,” she says.

This story was produced in partnership with Nashville Public Radio and Kaiser Health News.

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