美国国家公共电台 NPR--In Tennessee, a Medicaid mix-up could land you on a 'most wanted' list

In Tennessee, a Medicaid mix-up could land you on a 'most wanted' list

Transcript¹

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."

The state of Tennessee accused her of living in nearby Horn Lake, Mississippi, while still being enrolled² 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 alleged³ 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 Inspector⁴ 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 narcotics⁵ to sell on the street. But as federal rules have slowed the illegal prescription⁶ drug market, arrests related to Medicaid are instead sweeping⁷ 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 "eluded⁸" 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 prosecutors⁹ show her the evidence so she could refute the charges and clear her name.

The explanation ended up being pretty straightforward¹⁰. 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 license¹¹ still had the outdated¹² 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 anonymous¹³ even after they've agreed to reimburse¹⁴ 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 deterrent¹⁵: "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 offenses¹⁶.

"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 previously¹⁷ 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. Millions of Americans could lose their Medicaid coverage¹⁸ as a result. It's up to each state to determine who is eligible¹⁹ 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 eligibility²⁰, Johnson says recipients²¹ shouldn't have to worry that a mistake could eventually get them arrested.

Despite the ordeal²² she went through, Ingram is bouncing back. Still, she has legal bills to pay and has grown more frustrated²³ at being ensnared by the state's Medicaid dragnet.

"They made a big mistake," she says.

1 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

2 enrolled   

adj.入学登记了的v.[亦作enrol]( enroll的过去式和过去分词 )；登记，招收，使入伍（或入会、入学等），参加，成为成员；记入名册；卷起，包起

参考例句：

• They have been studying hard from the moment they enrolled. 从入学时起，他们就一直努力学习。 来自《简明英汉词典》
• He enrolled with an employment agency for a teaching position. 他在职业介绍所登了记以谋求一个教师的职位。 来自《简明英汉词典》

3 alleged   

a.被指控的，嫌疑的

参考例句：

• It was alleged that he had taken bribes while in office. 他被指称在任时收受贿赂。
• alleged irregularities in the election campaign 被指称竞选运动中的不正当行为

4 inspector   

n.检查员，监察员，视察员

参考例句：

• The inspector was interested in everything pertaining to the school.视察员对有关学校的一切都感兴趣。
• The inspector was shining a flashlight onto the tickets.查票员打着手电筒查看车票。

5 narcotics   

n.麻醉药( narcotic的名词复数 )；毒品；毒

参考例句：

• The use of narcotics by teenagers is a problem in many countries. 青少年服用麻醉药在许多国家中都是一个问题。 来自《现代汉英综合大词典》
• Police shook down the club, looking for narcotics. 警方彻底搜查了这个俱乐部，寻找麻醉品。 来自《简明英汉词典》

6 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

7 sweeping   

adj.范围广大的，一扫无遗的

参考例句：

• The citizens voted for sweeping reforms.公民投票支持全面的改革。
• Can you hear the wind sweeping through the branches?你能听到风掠过树枝的声音吗？

8 eluded   

v.（尤指机敏地）避开( elude的过去式和过去分词 )；逃避；躲避；使达不到

参考例句：

• The sly fox nimbly eluded the dogs. 那只狡猾的狐狸灵活地躲避开那群狗。 来自《现代汉英综合大词典》
• The criminal eluded the police. 那个罪犯甩掉了警察的追捕。 来自《现代英汉综合大词典》

9 prosecutors   

检举人( prosecutor的名词复数 )； 告发人； 起诉人； 公诉人

参考例句：

• In some places,public prosecutors are elected rather than appointed. 在有些地方，检察官是经选举而非任命产生的。 来自口语例句
• You've been summoned to the Prosecutors' Office, 2 days later. 你在两天以后被宣到了检察官的办公室。

10 straightforward   

adj.正直的，坦率的；易懂的，简单的

参考例句：

• A straightforward talk is better than a flowery speech.巧言不如直说。
• I must insist on your giving me a straightforward answer.我一定要你给我一个直截了当的回答。

11 license   

n.执照，许可证，特许；v.许可，特许

参考例句：

• The foreign guest has a license on the person.这个外国客人随身携带执照。
• The driver was arrested for having false license plates on his car.司机由于使用假车牌而被捕。

12 outdated   

adj.旧式的，落伍的，过时的；v.使过时

参考例句：

• That list of addresses is outdated,many have changed.那个通讯录已经没用了，许多地址已经改了。
• Many of us conform to the outdated customs laid down by our forebears.我们许多人都遵循祖先立下的过时习俗。

13 anonymous   

adj.无名的；匿名的；无特色的

参考例句：

• Sending anonymous letters is a cowardly act.寄匿名信是懦夫的行为。
• The author wishes to remain anonymous.作者希望姓名不公开。

14 reimburse   

v.补偿，付还

参考例句：

• We'll reimburse you for your travelling expenses.我们将付还你旅费。
• The funds are supposed to reimburse policyholders in the event of insurer failure.这项基金将在保险公司不能偿付的情况下对投保人进行赔付。

15 deterrent   

n.阻碍物，制止物；adj.威慑的，遏制的

参考例句：

• Large fines act as a deterrent to motorists.高额罚款是对开车的人的制约。
• I put a net over my strawberries as a deterrent to the birds.我在草莓上罩了网，免得鸟歇上去。

16 offenses   

n.进攻( offense的名词复数 )；（球队的）前锋；进攻方法；攻势

参考例句：

• It's wrong of you to take the child to task for such trifling offenses. 因这类小毛病责备那孩子是你的不对。 来自《简明英汉词典》
• Thus, Congress cannot remove an executive official except for impeachable offenses. 因此，除非有可弹劾的行为，否则国会不能罢免行政官员。 来自英汉非文学 - 行政法

17 previously   

adv.以前，先前（地）

参考例句：

• The bicycle tyre blew out at a previously damaged point.自行车胎在以前损坏过的地方又爆开了。
• Let me digress for a moment and explain what had happened previously.让我岔开一会儿，解释原先发生了什么。

18 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

19 eligible   

adj.有条件被选中的；(尤指婚姻等)合适(意)的

参考例句：

• He is an eligible young man.他是一个合格的年轻人。
• Helen married an eligible bachelor.海伦嫁给了一个中意的单身汉。

20 eligibility   

n.合格，资格

参考例句：

• What are the eligibility requirements? 病人被选参加试验的要求是什么？ 来自英汉非文学 - 生命科学 - 回顾与展望
• Eligibility for HINARI access is based on gross national income (GNI). 进入HINARI获取计划是依据国民总收入来评定的。

21 recipients   

adj.接受的；受领的；容纳的；愿意接受的n.收件人；接受者；受领者；接受器

参考例句：

• The recipients of the prizes had their names printed in the paper. 获奖者的姓名登在报上。 来自《简明英汉词典》
• The recipients of prizes had their names printed in the paper. 获奖者名单登在报上。 来自《现代英汉综合大词典》

22 ordeal   

n.苦难经历，（尤指对品格、耐力的）严峻考验

参考例句：

• She managed to keep her sanity throughout the ordeal.在那场磨难中她始终保持神志正常。
• Being lost in the wilderness for a week was an ordeal for me.在荒野里迷路一星期对我来说真是一场磨难。

23 frustrated   

adj.挫败的，失意的，泄气的v.使不成功( frustrate的过去式和过去分词 )；挫败；使受挫折；令人沮丧

参考例句：

• It's very easy to get frustrated in this job. 这个工作很容易令人懊恼。
• The bad weather frustrated all our hopes of going out. 恶劣的天气破坏了我们出行的愿望。 来自《简明英汉词典》