The following is an excerpt from a letter I sent Tennessee’s Dept. of Disability and Aging in September 2024.

Some of the Costs Caused by the Misconduct and Fraud of TennCare Health Plan Administrators and Providers.

The following section which I have titled “Some of the Costs Caused by the Misconduct and Fraud of TennCare Health Plan Administrators and Providers” is excerpted and mildly revised from a document drafted in 2024 prior to my June 18-22nd injury and incapacitation. The document was part of my prep for trying to refile my lawsuit against TennCare in federal court. My abuse and disability related injury and incapacitation has prevented me from continuing my pro se litigation efforts. 

Section – Billions wasted every year by TennCare explained, and as asserted by the American With Disabilities Act. 

•  TennCare has $14b annual budget. If 5% of budget is lost to waste/fraud related to recipients being deprived of rehabilitative care with reasonable promptness, that equals $700m a year. Recipients disabled by treatable illness due to TennCare misconduct also undermines the SSA program. SSI payments monthly per 1000 recipients, $943×1000+admin costs. Admin costs can be calculated by the pie chart percentages from SSA 2022-2023 Budget report to congress. If SSI costs 4% and admin costs 35% then 35/4=8.75. therefore, (943×1000)8.75=(943,000)8.75=8,251,250
• TennCare has 1.4 million recipients. When TennCare’s misconduct prevents rehabilitative care it leaves people disabled and on SSI when they otherwise could work. Per 1000 individuals like me who are disabled by treatable/curable illness receiving SSI, the cost of SSI payments per month per 1000 persons receiving $943 a month is $943,000. SSI payments make up 4% of the SSA annual budget. Administering the SSI program costs 35% of the SSI program. It costs 8.75 dollars to administrate each dollar of SSI payment. Providing SSI payment to those 1000 recipients has an administrative cost of $8,251,250 per month. For every 1000 SSI recipients on TennCare who remain disabled due to TennCare  preventing rehabilitative care it costs the SSA $9,194,250 per month and $110,331,000 per year. If only 10,000 of the 1.4 million TennCare recipients remain disabled and on SSI because of TennCares misconduct then that costs the SSA $1,103,310,000 per year. If just 5% of TennCares annual 14b budget is wasted due to TennCares misconduct preventing needed care that is 700m a year. Accepting the waste/fraud cost to be between 5-15% that is 700m-2.1b a year. If there are 10,000 people like me not being able to get the care that we need, then waste/fraud costs to TennCare and the SSA are 1.8b-3.2b a year. Tenncares misconduct will do more than just cause issues for the SSA and SSI programs but extend to other departments and programs. I received food stamps at about $220 a month (reduced to $135 a month for reasons unknown in July). For every 1,000 people receiving a similar amount, $220,000 a month, $2,640,000 a year. For 10,000 persons, $2,200,000 a month, $26,400,000 a year. We could go program by program adding up more and more costs but the point is only to illustrate that TennCare engaging in misconduct leads to other agencies having inflated costs as well and those in turn will lead to costs throughout society both in the private sector and throughout community programs. It is just as Congress said in the Americans with Disabilities Act that disability discrimination, the violation of our rights by the state and by private entities, leads to billions of dollars of waste every year. This is a very real and ongoing harm that manifests in individuals such as myself who are being physically and psychologically tortured. That the illegal activities of TennCare can have such far-reaching consequences makes their conduct all the more intolerable and illustrates the necessity that we must take action not just for my sake but collectively for all those like me and everybody else in the community, even for citizens who have no disability related needs. This is a matter of national importance, It is not merely a matter of me having a small private grievance.

[End Revision of Original Document]

[Addendum, Supplemental Charts]

Fig. 1 – Benefits And Administrative Budget By Program [Social Security Administration. (March 2022). FY 2023 Congressional Justification. Pg. 7]:

Fig. 2 – Chart made from the analysis of costs performed in above paragraphs