LaShonia Ingram was one in every of 28 Medicaid beneficiaries in Tennessee charged with TennCare fraud final 12 months. The District Lawyer dropped the felony fees.

Brad Vest/WPLN

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Brad Vest/WPLN

LaShonia Ingram was one in every of 28 Medicaid beneficiaries in Tennessee charged with TennCare fraud final 12 months. The District Lawyer dropped the felony fees.

Brad Vest/WPLN

Life was upended for LaShonia Ingram during the last 12 months, and a shadow nonetheless follows her round.

Search her identify 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 had been being closed in my face.”

Ingram resorted to promoting purses out of her trunk to assist 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 dwelling in close by Horn Lake, Mississippi, whereas nonetheless being enrolled within the state’s Medicaid program, often called TennCare. All of it turned out to be a mix-up, however the injury to her popularity and funds was accomplished.

Tennessee is among the most aggressive states within the nation with regards to policing doable Medicaid fraud amongst beneficiaries like Ingram. The state posts the names and pictures of individuals arrested for alleged fraud on a authorities web site and social media. Some even wind up on a so-called “most wished” checklist, as in the event that they had been harmful and on the run.

The checklist is maintained by Tennessee’s Workplace of Inspector Common. The workplace was launched in 2005 when many of the circumstances concerned drug diversion: individuals had been accused of utilizing TennCare advantages to amass 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 a substitute sweeping up individuals accused of transferring out of state — typically throughout the similar neighborhood — with out canceling their advantages.

An obvious clerical error results in an arrest

Ingram was one in every of 28 Medicaid beneficiaries in Tennessee charged in 2022, in line with the Tennessee OIG; greater than a 3rd of them had been accused of not being a Tennessee resident, with many circumstances originating within the Memphis space the place among the suburbs are in Mississippi.

In Ingram’s case, Tennessee introduced her arrest in a press launch, saying she “eluded” authorities for practically a 12 months. Ingram says she did not have a clue in regards to the fees 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, ‘stop mendacity,'” she remembers. “I’ve by no means been in hassle 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 may refute the fees and clear her identify.

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

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

Most states concentrate on well being care supplier fraud

Each state has an workplace to research Medicaid fraud dedicated by medical doctors and different well being care suppliers, since that is normally the place probably the most cash may 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 identify 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” checklist for its Medicaid program. He says it is speculated to be a deterrent: “It is to not blast anybody or defame anybody. It is to easily deal with the enterprise that is at hand, maintain individuals accountable and do what we’re right here to do,” he says.

As drug-related circumstances have diminished, enforcement has more and more targeted on making certain that individuals enrolled in TennCare stay within the state. In Memphis, 20 of the 27 Medicaid fraud circumstances since 2019 concerned questions of state residency, in line with the Shelby County District Lawyer. And prosecutors have dropped a minimum of a half dozen of these circumstances 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 dear. 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 normally low-income to begin with. Even when the state recovered each greenback from fees introduced in opposition to beneficiaries in 2022, the overall would quantity to lower than $900,000. The workplace has a price range of $6.4 million a 12 months. Since its creation in 2005, the OIG has introduced in lower than $10 million and charged practically 3,200 individuals with fraud, in line with its personal press releases.

And the speed of arrests has slowed dramatically. It now arrests fewer individuals in a 12 months 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 earnings and addresses over the subsequent 12 months. Million of People may lose their Medicaid protection in consequence. It is as much as every state to find out who’s eligible and tips on how to cope with potential fraud in this system.

Michele Johnson, govt director of the Tennessee Justice Middle, says policing fraud amongst TennCare beneficiaries takes money and time that may very well be spent on one thing extra useful.

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

Particularly now, as Medicaid applications are restarting checks on eligibility, Johnson says recipients should not have to fret {that a} mistake may 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 pissed off at being ensnared by the state’s Medicaid dragnet.

“They made a giant mistake,” she says.

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