Cooper calls for outside agency to audit TennCare
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Cooper’s request comes after a company named Market Models recently evaluated 1,687 TennCare applications. These were applicants – not people already on the TennCare rolls.
Of these applicants, 24 percent were determined to be out-of-state residents, 8 percent were deceased and 20 of the Social Security numbers were outside the range of Social Security numbers, according to Cooper.
“I am disturbed by these figures and have been demanding for a long time that the executive branch which manages TennCare find ways to eliminate waste, fraud and abuse,” said Cooper. “It is not the duty of the General Assembly to micro manage TennCare, but it is the duty of the General Assembly to say enough is enough.”
Market Models proposed a plan to match the entire TennCare enrollee file against its database for 20 cents per enrollee and update the file monthly for 2 cents per enrollee. Based on the 1.4 million people who are on TennCare, this would have an initial cost of $280,000 and a recurring monthly cost of $28,000.
“It’s a no-brainer,” said Cooper. “TennCare is costing us millions and we’re putting $327 million new dollars into TennCare next year. We can’t keep putting money into a mismanaged program. There’s a TennCare fraud system in place but it’s apparently not working.”
TennCare spokesperson Lola Potter does not agree with Cooper’s suggestion. She says state officials are aggressively finding and prosecuting people who are fraudulently on TennCare. As a result, 200,000 people have been kicked off TennCare in the past year.
“I don’t see any reason to pay an outside company when we can do this internally,” said Potter. “We need to continue finding areas of weakness, strengthening the laws, and prosecuting people once we find them. We don’t need to hire an outside agency to do this.”
Potter said TennCare has already matched its database against that of every major employer in Tennessee to catch people on TennCare who have access to other health insurance but aren’t accepting it. She also indicated TennCare is getting new computer technology which will make it easier to identify people fraudulently on the program.
TennCare is a $7 billion program that receives two-thirds of its funding from the federal government and the remaining one-third from Tennessee. It has been in existence since 1994.