Medicaid mess-up in Tennessee could land on ‘Most Wanted’ list

Life has turned upside down for Lashonia Ingram over the past year, and the shadow still follows her.

Search for his name online and the first result includes the words “fraud” and “most wanted”.

“It was terrible. I couldn’t find a job,” said the 42-year-old mother from Memphis, Tennessee. “All the doors were closing in my face.”

Ingram turned to selling purses out of her trunk to support her family. He said even DoorDash and Uber wouldn’t let him work on felony charges. His 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 turned out to be a mess, but his reputation and finances were damaged.

Each state has an office to investigate Medicaid fraud committed by doctors and other health care providers because that’s usually where the most money can be recovered. Few states push the sick the way Tennessee does. Tennessee publishes the names and photos of people arrested for alleged fraud on its government website and social media. Some even appear on the “most wanted” list.

The list is maintained by the Tennessee Office of Inspector General. The office was launched in 2005, when most cases involved drug diversion; people were accused of using TennCare benefits to obtain large amounts of drugs to sell on the street. But because federal rules have slowed the illegal prescription drug market, Medicaid-related arrests have instead resulted in people accused of moving out of state, often within the same community, without having their benefits revoked.

Ingram was one of 28 Medicaid beneficiaries in Tennessee charged in 2022, according to the Tennessee OIG; More than a third of those charged were not Tennessee residents, with many of the cases originating in the Memphis area, where the suburbs straddle Mississippi.

In Ingram’s case, Tennessee announced his arrest in a press release that said he had eluded authorities for nearly a year. Ingram said he had no knowledge of the charges until he received the ticket for wearing his seat belt.

“They pulled me over and said: And I said: “Stop lying,” she recalled. “I have never faced difficulties in my life.”

It took $2,000 to get out of jail and even more to hire a lawyer. More than six months later, prosecutors showed him the evidence so he could deny the charges and clear his name.

The explanation ended up being pretty simple. While she was on Medicaid in Tennessee 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 an outdated Mississippi address.

After his arrest, Ingram showed up on Tennessee rent and electricity bills, and the Shelby County District Attorney dropped the felony charges.

“We’re trying to apply the law compassionately,” Chad Holman, who heads the TennCare OIG, told KHN.

Other states have fraud investigation units that focus on patients, but they don’t necessarily name the accused publicly, which is what happens in Tennessee. For example, South Carolina keeps the accused anonymous even after they agree to pay restitution to the state.

Holman defends Tennessee’s practice of posting a “most wanted” list for its Medicaid program. He said that it should be a deterrent. “It’s not about blasting anyone or discrediting anyone. It’s just a matter of taking care of the business at hand, holding people accountable and doing what we’re here to do,” he said.

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

Holman said his office will not ignore low-level offenses.

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

Holman acknowledged that running TennCare’s fraud unit costs far more than the office will ever recover from people on Medicaid, who are typically low-income. Even if the state recovered every dollar of charges filed against beneficiaries in 2022, the total would be less than $900,000. The office’s annual budget is $6.4 million. Since its inception in 2005, the OIG has brought in less than $10 million in revenue and charged nearly 3,200 people with fraud, according to its press releases.

The number of arrests has decreased dramatically. It now arrests fewer people in a year than it did in a month.

About 1 in 4 Americans are on Medicaid or CHIP, the Children’s Health Insurance Program. The number of registered people has increased by more than 20 million since the beginning of 2020. And for the first time since the pandemic began, states will resume income and address verification next year. Millions of Americans could lose their Medicaid coverage as a result. Each state must decide who is eligible and how to handle potential fraud in the program.

Michelle Johnson, executive director of the Tennessee Justice Center, said policing fraud among TennCare beneficiaries takes time and money that could otherwise be spent on something more useful.

“It would be great if our leaders got out of the ‘gotcha game’ and into the ‘getting people healthy game,'” he said.

As Medicaid programs resume eligibility checks, Johnson said recipients shouldn’t worry that a mistake could end up getting them arrested.

Despite his ordeal, Ingram bounces back. Still, he has legal bills to pay and is even more frustrated that he’s trapped in the state’s Medicaid network.

“They made a big mistake,” he said.

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

KHN (Kaiser Health News) is a national news outlet that produces in-depth reporting on health issues. Along with policy analysis and research, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides information to the nation on health issues.


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