Policy allows criminals to re-enroll in TennCare - WSMV Channel 4

Policy allows criminals to re-enroll in TennCare

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NASHVILLE, TN (WSMV) -

The state spends a lot of time finding and arresting people who cheat on TennCare, but investigators also find themselves in a surprising position. No matter what a TennCare patient does, he or she cannot be kicked off the program.

There is no crime too heinous to forfeit TennCare benefits.

Edward Condra is accused of doctor shopping his way to 400 oxycontin pills in just 30 days. The Office of the Inspector General has charged Condra with TennCare fraud, so he faces prison.

But he does not face losing his TennCare.

"We have, in fact, asked the federal government for that authority to remove people from the program who have defrauded the program. The federal government has denied that request, basically saying Medicaid is an entitlement program and so long as you meet the qualifications for the program, you're entitled to receive those benefits," said TennCare spokeswoman Kelly Gunderson.

Condra has been in and out of jail since 2000 and has faced 31 different charges for things like domestic violence and aggravated assault.

But even if he goes to jail for this alleged pain pill scheme, he can pop right out and get back on TennCare.

Keep in mind there is a waiting list for other people hoping to get on TennCare. They're not poor, but they don't make a lot of money. And they have catastrophic medical bills.

Those are the people seeing Condra, and others like him, taking their place.

"It comes down to right and wrong, and these people are simply taxpaying Tennesseans trying to do the right thing, who otherwise would be eligible, but they can't get that spot because somebody else is taking it," said State Rep. Darren Jernigan, D-Old Hickory.

Jernigan sits on the House health committee but knows that it's not the state, rather it's the feds, who are insisting on keeping criminals on TennCare.

"It would infuriate me to know that I'm trying to get on the phone, I'm trying to get on TennCare, and someone gets out of prison and re-signs right back up because they were on before. So that is definitely something to be changed," Jernigan said.

TennCare is based on income and certain qualifications. Pregnant women and children in poverty get special consideration.

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