2023-02-23

In Tennessee, a Medicaid Mix-Up Might Land You on a ‘Most Wanted’ List

Life was upended for LaShonia Ingram over the past 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,” said 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 said even DoorDash and Uber wouldn’t allow her to work with a felony charge. Her alleged crime? Fraud.

The state of Tennessee accused Ingram of living in nearby Horn Lake, Mississippi, while still 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.

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. Few states crack down on patients as Tennessee does. Tennessee posts the names and photos of people arrested for alleged fraud on a government website and social media. Some even wind up on a “most wanted” list.

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.

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 suburbs extend into Mississippi.

In Ingram’s case, Tennessee announced her arrest in a press release, which said she eluded authorities for nearly a year. Ingram said she didn’t have a clue about the charges until she got a ticket for not wearing her seat belt.

“They pulled me over, and they said, ‘You have a felony warrant.’ And I said, ‘Quit lying,’” she recalled. “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. Ingram said 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.

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

Other states have fraud investigation units focused on patients, but they don’t necessarily name the accused publicly, which happens in Tennessee. For example, South Carolina keeps the accused 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 said 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 said.

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 said his office won’t overlook low-level offenses.

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

Holman acknowledged 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. 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 press releases.

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

About 1 in 4 Americans are 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 will resume verifying income and addresses over the next year. Millions 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, said policing fraud among TennCare beneficiaries takes time and money that otherwise 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 said.

As Medicaid programs restart checks on eligibility, Johnson said, recipients shouldn’t have to worry that a mistake could eventually get them arrested.

Despite her ordeal, 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 said.

This story is part of a partnership that includes WPLN, NPR, and KHN.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.