Prosecutors discovered issues with the Medicaid fraud case against Gregg and Tara Garner, the husband-and-wife duo behind Global Outreach Developments in Nashville, new details from the now-closed case show.
The Garners were accused in March 2021 of deceiving the state's medical assistance program by failing to report business income that would have disqualified family members from receiving health insurance benefits.
New evidence suggests the family behind the faith-based nonprofit was mistakenly enrolled in TennCare after a phone call between a Medicaid representative and a family assistant. During the call, the assistant identified herself as Tara Garner.
"It was evident to us that the Garners did not actively put their kids on TennCare," Assistant District Attorney Chadwick Jackson said this summer in conversations with The Tennessean. “It was this person trying to figure out the health insurance situation who did it by accident.”
Jackson did not name the assistant, who is unlikely to face charges, Jackson said.
"That person came in for an interview, and we could not find criminal intent," he said.
The Medicaid program paid more than $18,000 for health care services for the family, according to a news release distributed following the initial investigation. The children received program benefits between November 2015 and the end of 2017.
Further investigation revealed the family assistant was tasked with sorting out health insurance for the Garner children and called TennCare with the intent of receiving a denial letter that would be used to process private insurance.
However, a TennCare representative incorrectly said the children were eligible. Because the assistant believed the representative to be correct, she registered them for TennCare, investigators discovered.
Repeated efforts to reach the Garners' attorney, Bill Ramsey, were unsuccessful. In a previous phone interview with The Tennessean, Ramsey said prosecutors agreed to drop the charges when presented with the family's evidence.
"These charges ended up being not well-founded," Ramsey said on Aug. 16.
"The district attorney's office is very ethical. They looked at the evidence we had and said, 'You're right,' and they did the right thing and dropped the charges."
Lawsuit: TennCare’s verification system ‘rife with errors’
TennCare's rubric is complex and a person's eligibility can change year-to-year as children age or a family's finances shift. In recent years, critics have flagged inefficiencies at the agency that they say leave some of Tennessee's most vulnerable without needed health care coverage. The agency has announced efforts to update a largely paper-based review process, and many say the changes cannot come soon enough.
A 2020 lawsuit against TennCare claims the "defective process" by which the agency verifies eligibility is “rife with errors” that cause people to improperly lose coverage. In August, a federal judge refused to reinstate coverage for Tennesseans who lost coverage but cleared the way for others to join the lawsuit should they lose coverage later this year if the COVID-19 public health emergency designation ends.
The Garner case was initially investigated and made public by the Tennessee Office of Inspector General. The Office of Inspector General denied the Tennessean's request for files related to the investigation as they are excluded from state public records laws.
Audio recordings sealed case’s fate
The crux of the case, Jackson said, was an audio recording of the conversation that was initially believed to be between Tara Garner and a TennCare representative. It was later discovered the voice on the phone was the Garners' assistant.
The state in January 2021 presented the case to a Davidson County grand jury, which led to a sealed indictment against the couple.
"This is a very, very odd sequence of events that came about, and we did not find out all of that until after (Assistant District Attorney) General (Mindy) Vinecore and I got the case and dug into it and realized there were some issues," Jackson said.
"It turned out that it wasn't the Garners on those audio recordings."
Previously:TennCare sued by kids who lost Medicaid
It's unclear if an investigator with the Office of Inspector General spoke with the Garners before handing the case to the District Attorney's Office. Lola Potter, a spokesperson for the Office of Inspector General, said she could not answer questions about specific investigations but said, generally, tips pertaining to potential fraud are "vetted to see if there is information that clearly confirms or nullifies the allegation," including interviewing people at the center of those claims.
"If our information determines the allegation to be credible enough to justify continued investigation, we move forward to gather more information," Potter added. "Once we exhaust all information trails, a determination is made whether to submit the information to the district attorney general for grand jury review."
The investigative process can take several months, Potter said, and the average lifespan of a case is more than 10 months. More than 3,000 people have been charged criminally with TennCare Fraud since the Office of Inspector General began investigations in 2005.
Garners send off check, case dismissed
The couple was initially accused of receiving unreported income from Hopewell Family Care, the Califarmia food truck and Music City Handyman — all enterprises connected with the Garners.
The combined income would have made the family ineligible for the state-subsidized health care program, initial investigators said.
In fact, the family had private insurance at the time in question, Jackson confirmed, and providers were billing services to it.
Amy Lawrence, a spokesperson for TennCare, said for most eligibility categories, a person can enroll in private insurance and TennCare.
"In those cases the private insurance pays first and TennCare pays last," Lawrence said. "Under federal law, Medicaid is considered the payer of last resort."
After the criminal case fell apart, prosecutors and the Office of Inspector General agreed repayment of the $18,112.06 would be a satisfactory outcome.
Records obtained from the Office of Inspector General show that Gregg Garner on July 15 collected a cashier's check. The check was passed along to the district attorney's office and forwarded to the Bureau of TennCare on July 21.
One week later, the cases were dismissed.
Contact Tennessean reporter Kirsten Fiscus at 615-259-8229 or KFiscus@gannett.com. Follow her on Twitter @KDFiscus. Reach reporter Mariah Timms at firstname.lastname@example.org or 615-259-8344 and on Twitter @MariahTimms.
This article originally appeared on Nashville Tennessean: Prosecutor: Fraud case against Global Outreach founders was flawed