Not Feasible: Co-Chair of Tennessee’s Federal Funding Task Force Says Rejecting All $1 Billion-Plus in Federal Education Money Isn’t Possible

As Tennessee lawmakers investigate the possibility of just saying no to federal education funds and the ties that come with them, the state’s Federal Funding Working Group co-chair told The Tennessee Star that completely letting go probably isn’t going to happen.

“No, I don’t think that’s feasible,” said State Senator Jon Lundberg (R-Bristol) in an interview this week with The Star.

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Tennessee Gov. Lee Pitches Plan to Expand Support for Pregnancy Care Centers to $100 Million

Governor Bill Lee (R-TN) announced Monday during his State of the State address he would propose boosting support for women in unplanned pregnancies through various programs, including an expansion in funding for crisis pregnancy care centers to $100 million, widening Medicaid eligibility for pregnant women and parents, and granting additional paid family leave time for state employees.

Tennessee’s “trigger” law that bans abortion, titled the Human Life Protection Act, took effect August 25, two months after the U.S. Supreme Court overturned Roe v. Wade.

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TennCare to Spend $500M Because of Enrollment from COVID-19 Pandemic

TennCare currently has $1.1 billion in its reserves and expects it to cost $500 million of those reserves over the next year as it redetermines Medicaid eligibility for those additional 500,000 members who joined the plan over the past three years.

During the COVID-19 pandemic, states were not allowed to remove those who are no longer eligible for the program as previous. Starting on April 1, states must start that redetermination process and will have a year to complete it.

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Audit: Hall Medical Clinic in Waynesboro Received $300K in Excess TennCare Payments

A recently released audit shows the Hall Medical Clinic in Waynesboro received more than $300,000 in TennCare funding payments due to underreporting the payments the clinic received.

In an audit conducted by the Tennessee Comptroller’s Office, the clinic was found to have not reported $621,775 in payments and 2,340 TennCare visits to the clinic between 2017 and 2021.

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The Number of Medicaid Recipients Will Soon Top 100 Million U.S Residents: Report

The United States will have 100 million residents on Medicaid in the next 72 days, according to the Foundation for Government Accountability, meaning that nearly one-third of all Americans will be on the program for health care.

Over the past three years, states have been prevented from removing recipients from the program through a federal COVID-19 emergency. Now, the date when states can begin to re-registering recipients when that emergency ends on April 1.

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TennCare Costs Will Increase as Emergency COVID Waiver Ends

Throughout the federal COVID-19 emergency, Tennessee’s Medicaid service TennCare and programs like it across the country have been barred from removing those who initially qualified for services.

Starting on April 1, however, the emergency will end and so will the federal matching dollars that went into the program. TennCare served 1.4 million residents in early 2020 and, after hitting a projected peak of 1.7 million members this spring, expects TennCare enrollment to go back down to 1.4 million by April 2025.

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Tennessee Arrests ‘Most Wanted’ Person for TennCare Fraud

Lindsey Horner, considered the “most wanted” person for TennCare fraud, was arrested Friday, according to a press release by the Tennessee Department of Finance and Administration (F&A).

The Tennessee Office of Inspector General (OIG), in a joint effort with the Benton County Sheriff’s Office, announced that the 39-year-old  Big Sandy, Tennessee, was charged with TennCare fraud and theft of services. The TennCare fraud charge is a class D felony, and the theft of services charge is a class C felony, the press release notes.

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Tennessee Clinic Overcharged TennCare Nearly $5 Million, New Audit Reveals

A west Tennessee primary care clinic overcharged TennCare — and, by extension, taxpayers — more than $4.7 million, according to an audit that Tennessee Comptrollers published late last week.

Officials who oversaw that company, the Grove Primary Care Clinic, closed all three of their facilities in 2019. They did this one day after state auditors announced they would examine the company’s finances.

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BlueCross BlueShield of Tennessee, a Near $1B Vendor to State Government and a TennCare Health Plan Contractor, Mandating Some Employees Get COVID-19 Vaccines and Not Allowing Religious Accommodation

BlueCross BlueShield of Tennessee (BCBST), which received nearly $1 billion in vendor payments from the State of Tennessee during fiscal year 2021 related to state employee healthcare benefits and is one of the Managed Care Organizations handling the state’s TennCare program is enforcing a COVID-19 vaccine mandate and not allowing religious accommodations for some of its employees.
Information was provided to The Tennessee Star by a long-term employee of BCBST, the Tennessee-based independent licensee of the Blue Cross Blue Shield Association, on the condition of anonymity for fear of losing their job.

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Lieutenant Governor Entertains Possibility of Expanding Medicaid

Lieutenant Governor Randy McNally (R-Oak Ridge) appears to have a change of heart on the possibility of expanding Medicaid in Tennessee. According to reports, the White House’s latest plan to expand subsidized coverage caught McNally’s fancy.

Via the American Rescue Plan, President Joe Biden promised that if states expanded their Medicaid programs they’d receive more federal dollars to cover the program. McNally’s spokespersons have indicated that he is open to this option.

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Governor Lee’s State of the State Address: a ‘Roaring’ Economy, Growth, and Investments in Local Communities

Despite the past year’s events, Governor Bill Lee had plenty of good news for Tennesseans in his State of the State Address. The General Assembly appeared to agree with the governor’s assessments – at many points throughout the address, their socially-distanced, masked audience rose to applaud Lee.

“Scripture has a lot to say about those crossroads and what to do on the heels of suffering. Where do we find promise in this season?” opened Lee. “The promise is found in perseverance which produces character that leads to hope. Tennesseans will know tonight that tragedy has no hold on who we are or where we are headed. Tragedy won’t define us, it won’t rob us of the opportunity that 2021 holds.”

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Tennessee Democrats Ask Biden Administration to Reverse Medicaid Block Grant Waiver

Tennessee Democrats have made multiple pleas to President Joe Biden’s administration, seeking to rescind federal approval for Tennessee’s Medicaid block grant waiver, which is set to allow the state to receive Medicaid funding in a lump sum.

Under the new funding mechanism known as a block grant, Tennessee would receive federal money for the state Medicaid program, TennCare, all at once instead of periodically.

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Tennessee Legislature Approves Modified Block Grant for State’s Medicaid Program

Tennessee’s General Assembly approved the Medicaid waiver, granting the state to apply federal healthcare funding to an aggregate gap model of spending. The legislature filed the bill when it first convened on Tuesday. Just three days after the bill’s introduction, legislators took their final votes on Thursday and Friday. The six subcommittees who reviewed the waiver all recommended its passage over the course of a few days.

The waiver allows the state to establish a self-imposed, fixed budget to last over a ten-year period, known as TennCareIII. It also allows the state to reserve a portion of the unused funds and apply them to other government programs, with potential for those savings to be matched with additional federal funds for healthcare programs.

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Federal Government Approves Tennessee’s Medicaid Proposal, Swapping a Block Grant for an Aggregate Cap

The federal government approved Tennessee’s proposed Medicaid aggregate cap, granting a lump sum for a self-imposed, fixed budget. The ten-year agreement, referred to as “TennCare III,” is the first of its kind nationwide. It also allows for the state to reserve any unused funds and apply them to other government programs, with up to 55 percent of those savings potentially matched by additional federal funds for state health programs.

The Centers for Medicare and Medicaid Services (CMS) described the measure as an “innovative financing approach.” Unlike what various reports claimed, federal officials explicitly stated that this agreement wasn’t a block grant. This agreement allows the state government to be flexible with its spending cap under certain circumstances – like last year’s pandemic and related unemployment crisis. 

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Tennessee Officials Charge Fayette County and Mississippi Women with TennCare Fraud

Tennessee officials have charged two women in separate cases, one from Fayette County and another from Mississippi, with TennCare fraud.

Authorities charged Shuvonda Barnett, 36, of Rossville, with 48 counts of TennCare fraud and two counts of theft of services over $10,000 but under $60,000, according to a Tennessee Department of Finance and Administration press release.

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Murfreesboro Man and South Carolina Woman Charged with TennCare Fraud

Authorities have charged a Murfreesboro man and a South Carolina woman with TennCare fraud, according to two statements the Tennessee Department of Finance and Administration released last week.

Authorities charged that Murfreesboro man, William Weed, 40 with TennCare fraud, a Class D felony, in connection with allegedly selling prescription drugs obtained using TennCare healthcare insurance benefits.

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North Carolina Woman Charged with TennCare Fraud

  Authorities have charged yet another out-of-state resident with TennCare fraud, and this time the alleged culprit is from North Carolina. According to a press release, officials with the Tennessee Office of Inspector General this week announced the arrest of Julie Carpenter of Mitchell County, North Carolina. The arrest is the result of a joint effort with the Mitchell County Sheriff’s Office of North Carolina.  Authorities transported her to the sheriff’s office of Johnson County, Tenn. where they have her housed, according to a press release. Carpenter is charged with one count of obtaining benefits through TennCare despite not qualifying for the program and one count of theft of services over $10,000, the press release went on to say. “Investigators say Carpenter reported that she had custody of her son when in fact the paternal grandparents of the child had court-ordered custody elsewhere,” according to the press release. “Additionally, it was discovered that Ms. Carpenter was not a resident of Tennessee and was in fact residing in Mitchell County, North Carolina.  Carpenter continued to report this status to TennCare over a period of approximately a year and a half.  Had Carpenter properly reported her household composition or out of state residency,…

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Tennessee Leads the Way by Being the First State to Propose Receiving Federal Medicaid Funding Through a Block Grant

Tennessee became the first state in the nation Tuesday to propose that $7.9 billion in federal funding for the state’s Medicaid program, known as TennCare, would be provided through a block grant.

The release of the 34-page proposal, TennCare II Demonstration Amendment 42, begins a 30-day public comment period, which will end on October 18, 2019.

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Woman Charged with Carrying out TennCare Fraud at Pharmacy

  In another blow for taxpayers, Tennessee officials have announced the arrest of yet another person charged with TennCare fraud. The Office of Inspector General, with help from the Henderson County Sheriff’s Office, this week announced the arrest of Paula Hutcherson, 50, of Parsons. Authorities charged her with two counts of TennCare fraud and five counts of obtaining and/or attempting to obtain a controlled substance by fraud, according to a press release. “Hutcherson, who works in the medical field, called in a prescription for Ambien, a Schedule IV controlled substance, to a pharmacy by using the name of a provider she did not have permission to use and knowingly used the name of a TennCare enrollee in order to use their TennCare benefits to pay for the prescriptions,” the press release said. District Attorney General Jody Pickens is prosecuting.  TennCare fraud is a Class D felony punishable by up to four years in prison per charge, the press release said. The OIG, which is separate from TennCare, began full operation in February 2005 and has investigated cases leading to more than $3 million being repaid to TennCare, with a total estimated cost avoidance of more than $163.6 million for TennCare, according to…

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Tennessee Officials Charge Even More People with TennCare Fraud

  The number of people state officials have charged with TennCare fraud continues to grow, meaning state taxpayers still subsidize alleged waste, fraud, and abuse out of the program. This, according to two press releases the Tennessee Office of Inspector General released this week. Authorities charged a Wilson County woman with TennCare fraud in both Wilson and Davidson counties because of the woman’s alleged doctor shopping for controlled substances. OIG officials said that woman, Datha Kimberly Robertson, 26, of Lebanon, used TennCare to doctor shop for the painkiller Oxycodone. A Wilson County indictment accuses her of three counts of fraudulently using TennCare to doctor shop. “Upon posting bond, Robertson was arrested for the second time in Davidson County, where she faced an indictment charging her with two counts of TennCare fraud for doctor shopping for the painkiller Hydrocodone; and, one count of obtaining a controlled substance by fraud,” according to the press release. “Authorities say that during a six-week period, Robertson had five visits to a hospital emergency room, doctor’s offices and urgent care.  In each of the incidents, she used TennCare to obtain controlled substances, while failing to disclose that she’d received previous similar drugs.  The charges in both…

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State Sen. Dickerson, Others in Pain Management Business Sued By United States, Tennessee for Allegedly Committing $25M in Medicare, TennCare Fraud

  State Sen. Steven Dickerson (R-TN-20) is among those being sued by the federal government and Tennessee over alleged Medicare and TennCare fraud totaling at least $25 million. The United States and Tennessee on Monday filed a consolidated complaint in intervention alleging violations of the False Claims Act and the Tennessee Medicaid False Claims Act by Anesthesia Services Associates, PLLC, doing business as Comprehensive Pain Specialists (CPS), according to a statement by U.S. Attorney Don Cochran for the Middle District of Tennessee and Tennessee Attorney General Herbert Slatery III. The governments allege that the scheme defrauded Medicare and TennCare of at least $25 million. The complaint also names as defendants Dr. Peter B. Kroll, of Goodlettsville; Dr. Steven R. Dickerson, of Nashville; and Dr. Gilberto A. Carrero, of Nashville, three of the principal owners of CPS, as well as John Davis, of Franklin, the former CEO, who was convicted by a jury in April of violating the Anti-Kickback Statute; and Russell S. Smith, a chiropractor from Cleveland. The complaint also states claims for violation of the Federal Priority Statute and common law claims, including unjust enrichment and fraud. A federal judge in April granted prosecutors’ requests to intervene in whistleblower complaints…

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Georgia Residents Are Allegedly Robbing Tennessee Taxpayers Through TennCare Fraud

  People from Georgia are robbing the taxpayers of Tennessee by taking TennCare benefits to which, legally, they are not entitled. This, according to The Atlanta Journal Constitution, which said authorities are investigating 16 people in Georgia for receiving benefits from Tennessee’s Medicaid program. Those 16 Georgians likely couldn’t get health care coverage in their home state, the paper went on to say. This is currently the largest number of such cases originating from any state, the paper quoted Tennessee’s Office of the Inspector General as saying. “The impact’s huge,” Tennessee Inspector General Kim Harmon reportedly said. “I was just looking at some of our numbers — per person, the average annual cost per enrollee is $4,062 per month. That means that Tennessee taxpayers are funding 30 percent of that.” TennCare recipients must notify the state if they move, and they must periodically renew their status and state where they live, according to The Atlanta Journal Constitution. But the out-of-state cases of TennCare aren’t just coming out of Georgia. As The Tennessee Star reported last month, Tennessee officials announced they indicted five Alabama residents on charges of passing themselves off as Tennessee residents so they could qualify for TennCare. All…

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Authorities Say Nashville Man Stole from Taxpayers to Treat His ADHD

  The Tennessee Office of Inspector General announced several new TennCare fraud arrests this week, including the arrest of one man who allegedly used TennCare to treat his Attention Deficit Hyperactivity Disorder. That man, Thomas William Biggs Jr., 44, of Nashville, was on the run for more than a year and a half, according to a Tennessee Department of Finance and Administration press release. “Seventeen months ago, in January 2018, a Davidson County Grand Jury indicted Biggs for TennCare fraud, accusing him of using TennCare to doctor shop for drugs,” the press release said. “Charges say he used TennCare benefits to visit multiple healthcare providers within a short time period to obtain prescriptions for Adderall, an often-abused amphetamine used to treat attention deficit hyperactivity disorder (ADHD).” Elsewhere, according to another press release, authorities charged three Shelby County residents in separate TennCare fraud cases: • Alaa Ahmad, 40, of Memphis, charged with two counts of TennCare fraud and one count of theft of property over $10,000. Ahmad is accused of obtaining TennCare benefits by claiming his minor child was living with him when, in fact, the child lives out of the country. Without the dependent, Ahmad was not eligible for TennCare. •…

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Yet Another Alabama Resident Charged with TennCare Fraud

  Tennessee officials have charged yet another Alabama resident with TennCare fraud, according to a press release from the Tennessee Department of Finance and Administration’s website. This, even though only Tennessee residents are eligible for the TennCare program. Tennessee officials said they arrested Ladreamer Garrett, 27, of Bridgeport, Ala. and charged her with TennCare fraud and theft of services. Authorities said Garrett allegedly applied for and received TennCare benefits for herself and her minor child by fraudulently reporting her residency to appear eligible for TennCare. “Authorities say records show that a month before applying for TennCare, she signed a lease for her residence in Bridgeport, Alabama, where she and her child continue to live,” according to the press release. The Office of Inspector General, with the assistance of the Marion County Sheriff’s Office, announced the arrest. District Attorney General J. Michael Taylor is prosecuting.  TennCare fraud is a Class D felony punishable by up to four years in prison per charge. “Lying about one’s residence in order to receive TennCare benefits is a crime,” Inspector General Kim Harmon said in the press release. “We work diligently to preserve TennCare benefits for its intentional use.  We welcome information of anyone abusing the system.” As…

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