States have some control over Medicaid eligibility, and audits over the years have revealed cases where individuals failed to qualify in one state and received care fraudulently in another.
“The impact is huge,” Tennessee Inspector General Kim Harmon told the Atlanta-Journal-Constitution, stating the average annual cost per enrollee is $4,062, of which 30 percent is paid by the state.
The fact that an out-of-state resident even tries to get TennCare is an issue of concern in itself, says Tennessee Rep. Martin Daniel (R-Knoxville).
“I’m interested in the eventual findings of the investigation, but in any event we should take a look at our Medicaid program to ensure that ours is not overly generous, at the expense of Tennessee taxpayers,” Daniel told Health Care News.
Medicaid fraud is not uncommon, and states and the federal government periodically conduct audits. A 2015 report by the Foundation for Government Accountability describes the results of audits in Arkansas, Illinois, Minnesota, Nebraska, New York, and Ohio that uncovered violations such as the use of invalid Social Security numbers and unverified identity and income information. Louisiana recently removed 30,000 people from its Medicaid rolls because their incomes were too high.
Calls for Integrity
Tennessee should not turn a blind eye to Medicaid recipients living in other states, says Stephanie Whitt, executive vice president at the Beacon Center of Tennessee.
“It’s important to process eligibility timely but also maintain good program integrity against fraud, waste, and abuse,” said Whitt. “People who obtain benefits fraudulently should be prosecuted.”
Tennessee borders Georgia, making it relatively easy for Peach State residents to seek care there. Tennessee requires TennCare beneficiaries to notify the program of an out-of-state move.
As of early August, no indictments had been issued as a result of the investigation.
Jake Grant ([email protected]) writes from Alexandria, Virginia.
Jonathan Ingram, “Stop the Scam: How to Prevent Welfare Fraud in Your State,” The Foundation for Government Accountability, April 2, 2015: https://heartland.org/publications-resources/publications/stop-the-scam–how-to-prevent-welfare-fraud-in-your-state