Three days before what we thought would be my wife, Ruth Ellen’s, final surgery for stage three breast cancer, my mind was racing as I was trying to finish moving out of our old house while confirming plans for where our five kids would be staying during her procedure. After almost two years of chemotherapy, radiation and surgeries, we felt like we finally were going to be able to take a breath.
As I locked the door to our old house on the evening of July 18, 2023, I walked up the driveway and checked the mail one last time. Then in an instant, my heart sank in confusion, shock and fear as I opened a letter from South Carolina Attorney General Alan Wilson’s office informing us they were investigating Ruth Ellen for Medicaid fraud.
Rick Pidcock
“The South Carolina Attorney General’s Office received a request from the South Carolina Department of Health and Human Services to review information you have submitted which allowed you access to, and use of, Medicaid health care coverage,” the letter began. “It appears that the SC DHHS has concerns about the validity of some of this information. I am writing this letter to advise you that Mr. LaRone Washington, a Prosecutor for the South Carolina Attorney General’s Medicaid Recipient Fraud Unit, has reviewed the initial complaint from the SC DHHS. He has approved an investigation into these questions.”
The letter went on to say, “The accusation in this matter alleges criminal conduct,” with the last three words of that sentence underlined. It asked Ruth Ellen to meet with the prosecutors voluntarily, informed her of her right to remain silent, and added, “You do have a right to seek representation from a Criminal Defense Attorney.” But it warned, “Regardless of your decision, my investigation will continue with, or without, your input.”
With President Donald Trump and the GOP gearing up to go after “waste, fraud and abuse” in the Medicaid system, Americans need to have an honest conversation about how these government officials are going after poor and sick people they think are scamming the system.
“Americans need to have an honest conversation about how these government officials are going after poor and sick people they think are scamming the system.”
Sure, waste, fraud and abuse exist. And the result of these crimes is that less funds are available to help those in need. But if we’re going to improve our health care, we need to do so with compassion for those who are suffering and caution before putting people through unnecessary, terrifying investigations.
As you read our story, I hope it will open your awareness and heart to the reality that much of the injustice happening today isn’t due to poor people taking advantage of the system, but points to how inadequate and inconsiderate the system is.
‘A technical issue in our database’
Before I get to the allegations, I need to start by sharing a series of challenges with the Medicaid system we had leading up to it.
For the previous decade, our experience with Medicaid was rather smooth. We’d fill out our review each year. And because my income was always low, they approved our coverage. With five kids, there was no way we ever could have afforded to buy private insurance.
The chaos began in May 2023 due to Medicaid starting the annual review process for the first time since the COVID-19 pandemic. We received a letter on May 2, 2023, stating, “Medicaid eligibility for the following persons will end on the date listed below.” The date we were scheduled to lose coverage was June 1, 2023.
Of course, at this point we were very concerned because Ruth Ellen was in the middle of cancer treatments, with a major surgery coming up in July. How were we going to find an affordable health insurance coverage without disrupting her treatments? Would they allow her to keep her doctors? Was she not going to be able to have her final surgery?
“These are questions cancer patients shouldn’t have to ask.”
These are questions cancer patients shouldn’t have to ask.
But what was especially odd about the letter was the people it listed who would be losing their coverage were Ruth Ellen and my two daughters. Our three boys and I remained covered.
Why would Medicaid cancel coverage just for Ruth Ellen and the girls?
The letter told us, “In order to appeal the decision, you have to request a fair hearing with the South Carolina Department of Health and Human Services.”
We had questions about why only Ruth Ellen and the girls were losing coverage, as well as questions about how to report her income, given that the bonuses from her job were inconsistent. The application said if there was any information they couldn’t verify, an agency representative would contact her.
But nobody contacted her. Still, despite the reviewer’s silence, Ruth Ellen went out of her way to be proactive in contacting them, calling almost daily during the month of May and constantly being put on hold for around 30 minutes a day in hopes of getting some answers. The people she spoke with always told her she would receive word before June 1, when her coverage was set to expire.
Every person she spoke with expressed empathy and confusion about her situation and sent the case in for an emergency review. They told Ruth Ellen the emergency review would take three to seven business days. But she never heard back about any of the emergency reviews the entire month.
One case worker told Ruth Ellen to keep calling in because “they tend to drag their feet with these things.” When Ruth Ellen asked if she could talk to one of the reviewers, the case workers said that wasn’t possible.
A few days before the deadline, one representative told Ruth Ellen it might be quicker to go online and fill out an electronic review. So she did that.
“A technical issue in our database recently caused closure notices to be mailed in error.”
Then on June 2, 2023, the day after losing our coverage, we heard back from Medicaid. They admitted: “A technical issue in our database recently caused closure notices to be mailed in error. Our records indicate you received a notice inaccurately stating that Medicaid coverage would end for a member of your household. We are writing to let you know this coverage has not ended. We sincerely apologize for the error.”
Then the letter added, “You and the following members of your household now have health insurance through these health plans. These are the same health plans you had before with South Carolina Healthy Connections.”
It was all completely pointless. But when Ruth Ellen was being investigated one month later for supposedly giving the wrong information, I couldn’t help but notice this: When the government makes a mistake, it’s an understandable error. But when we mess up, it’s a crime.
Changing roles in December 2019
How did all this lead to a criminal investigation? To answer that, we eventually found out the issue had to do with when we switched jobs back in December 2019.
When I worked in the cleaning industry for two decades, we were barely making ends meet. Thus, we qualified for Medicaid. Then in December 2019, I closed my business to become a stay-at-home dad and to pursue my writing, while Ruth Ellen accepted a position as an assistant interior designer.
The amount of money she would make in that role was going to be the same as what I had made in the cleaning industry. There was no noticeable change in income for us. What changed and made it a financially beneficial move for us was that she would be receiving her income as a guaranteed salary, as opposed to my unpredictable cleaning sales where nothing was guaranteed. Also, she would have the potential of being promoted, which eventually could increase our income by allowing her to earn bonuses.
But suddenly, the COVID-19 pandemic hit and we had no idea when she would receive her promotion. We would be making the low salary for the foreseeable future.
COVID-19 and Medicaid reviews
One thing we were assured of during that time, however, was that our Medicaid coverage would continue. On March 18, 2020, President Trump signed into law the Families First Coronavirus Response Act, which paused the annual Medicaid eligibility reviews for the duration of the pandemic. In exchange for allowing Medicaid patients to keep their coverage, states received increased funding from the federal government.
“We received letters each year from South Carolina Healthy Connections that told us there was nothing we needed to do.”
Additionally, we received letters each year from South Carolina Healthy Connections that told us there was nothing we needed to do. For example, in a letter dated February 1, 2022, SCHC told us: “South Carolina Healthy Connections Medicaid is required to report your prior year health care coverage to the Internal Revenue Service. You, your spouse, and/or one or more of your dependents were enrolled in Medicaid in 2021. You do not have to do anything with the enclosed form. We report to the IRS on your behalf, and the enclosed form is provided only as a copy for your records.”
In the Consolidated Appropriations Act of 2023, signed by President Joe Biden on Dec. 23, 2022, the federal government allowed states to resume annual Medicaid eligibility reviews effective April 1, 2023.
We knew that date would be coming and there would be a chance we would lose our coverage in the middle of her cancer treatments. But when our review came up, we gave them our updated financial information and waited to hear back. That’s when we found out Ruth Ellen and the girls were losing coverage. After apologizing to us for that mistake, they extended our coverage through August to give them more time to review. But during that extension was when the attorney general’s office swooped in and decided to do a criminal investigation.
Scrambling for answers
Women who have breast cancer surgery shouldn’t be terrified of going to prison. They should be free to focus on healing and rest. But unfortunately, despite all her efforts to reach out during May and June, the South Carolina attorney general’s office took away Ruth Ellen’s freedom to focus on healing and rest.
Instead, three days before her surgery in July, they sent us a letter requiring us to respond to her prosecutor within two weeks. This meant we would have to make decisions while she was heavily medicated from the surgery — decisions that potentially could send her to prison.
“Three days before her surgery in July, they sent us a letter requiring us to respond to her prosecutor within two weeks.”
The obvious question we had was, “What information could she possibly have submitted that was wrong?” Surely there was some kind of misunderstanding here.
Because the letter didn’t tell us what false information she supposedly gave, we had no idea what it could be. So she called the number to find out. When the special investigator answered the phone, Ruth Ellen heard a clicking and a reel noise that sounded like he turned on a recording device.
She said, “Hello?” multiple times before there was any answer. This made her feel very uneasy. She said she was calling in regard to the letter she received. The investigator said he couldn’t speak at that time but wanted to arrange a time to talk. So Ruth Ellen said she would have to get back to him and hung up the phone.
We read some horror stories of people meeting with investigators to clear up a misunderstanding and then suddenly getting arrested. So given how hostile and manipulative the attorney general’s office seemed to be behaving, we felt we needed to hire a lawyer. Unfortunately, we had just spent what money we had moving into a different home.
But we felt we had no choice. We couldn’t figure out what she did wrong. And we had no idea how to defend ourselves against accusations they wouldn’t even share with us. So with what little money we had left, we hired a lawyer.
Our lawyer told us if this case went to trial, his services could cost us around $250,000. If that were to happen, we’d lose the house even if we won the case.
On July 20, one day before Ruth Ellen’s surgery, the special investigator emailed her, stating: “I am inquiring would you be willing to meet in Greenville County at a magistrate’s office to discuss the allegation outlined in the letter that was mailed to you. As the letter explained you do not have to meet me but the investigation will continue. If you are obtaining legal representation, please forward their name so I may contact them.”
The questions running through our minds in the final 24 hours before her surgery were unbearable. A significant portion of her income for 2023 was bonuses she may or may not get from month to month. So when people ask her to report her income, it can be difficult to be precise. She tried as best she could to answer the questions correctly. But was she misunderstanding something about how income was considered while filling out the forms?
We were reading stories of people found guilty of Medicaid fraud going to prison for five to 10 years. The penalty often was dependent on how much money they had benefited from. But because Ruth Ellen had spent the previous two years receiving cancer treatment, that would mean hundreds of thousands of dollars’ worth of fraud. Should we cancel her final cancer surgery, knowing the added cost might lead to a harsher penalty?
“Should we cancel her final cancer surgery, knowing the added cost might lead to a harsher penalty?”
Was she going to be sitting in a cage for a decade? Were we going to have to tell the kids they wouldn’t see their mom for the rest of their childhood? Was I going to be a single dad of five kids, experiencing foreclosure and having to find a job to pay our bills? The reason we were on Medicaid to begin with was that, as a janitor, I never could make enough money to take care of us well.
Ruth Ellen had to work full time during her treatments. She timed her chemo treatments so that her hardest days of recovery would be her two days off. She’d come home as a shell of herself and collapse. As much of a nightmare as that sounds, she said it would’ve been more stressful for her to stay home and take care of five kids and to know I’d be making less money than she could. She figured if she could beat cancer, we’d be in a great place financially for the future. And it kept her mind off of her personal struggles and onto her passions.
It made me so angry to see her being treated like a criminal, after everything she had survived. I wanted to call up the investigators and tell them off. But we were completely powerless. Neither of us could sleep. And then it was time to drive our five kids to the places they were staying so Ruth Ellen could go in for surgery.
Let’s make a deal
Fifty three days of stress later, we still had no idea what Ruth Ellen supposedly did wrong. When we met with our lawyer on September 9, 2023, he told us the investigators were claiming we hadn’t qualified for Medicaid for the previous two years, but they didn’t think she committed fraud intentionally. So he said they were leaning toward offering us a deal where we would have to lose our Medicaid coverage and then pay them back around $25,000 in order to make everything go away and avoid criminal charges.
On one hand, we were relieved to hear they weren’t pursuing criminal charges anymore. On the other hand, it felt like blackmail. And none of this made any sense. Because Ruth Ellen had cancer and we had five kids, even while being investigated for fraud, we went through the review process and were told we still qualified.
So how were we being required to give up our coverage and pay $25,000 when we still qualified?
“How were we being required to give up our coverage and pay $25,000 when we still qualified?”
Dropping the charges
On Nov. 7, 2023, which was 112 days of nightmarish stress after the initial letter telling us of the criminal investigation, our lawyer informed us the attorney general’s office was finally dropping the investigation.
Our lawyer told us: “I was able to get the AG’s office to close their investigation of you. I think the key point in their decision making process was understanding that even though you got a job in fourth quarter 2019, that would not have taken you off Medicaid prior to the Medicaid pause.”
Despite the drama the Medicaid system and the attorney general’s office put us through, we qualified for Medicaid the entire time. When we changed jobs in 2019, our income didn’t change. We also qualified due to a bill that was signed into law to pause the reviews. And we qualified due to higher income levels allowed for cancer patients and families of our size.
Having the investigation dropped was an immense weight off our shoulders that never should have been there to begin with.
Ongoing problems
But wait, there’s more. Since the charges have been dropped, we’ve continued getting random off-the-wall letters from Medicaid.
For example, we’ve been told our 13-year-old was losing coverage due to not being a resident of South Carolina, despite the fact he is a U.S. citizen and had been living in South Carolina with us for more than a decade.
“Since the charges have been dropped, we’ve continued getting random off-the-wall letters from Medicaid.”
We’ve received letters informing us our 10-year-old daughter was losing her coverage due to her making too much money, despite the fact that 10-year-olds are not legally allowed to hold a job.
We’ve also received letters addressed to our 6-year-old as head of the household.
In each of these situations, we have to go through an appeals process to prove our kids are residents, don’t have to have an income, and aren’t the head of the household.
Additionally, the word “annual” in “annual review” doesn’t mean yearly. It means whenever they want to put you through a review. One of the Medicaid supervisors told us we have to do it “whenever their computer decides to spit it out” and that “it’s impossible for a person to overturn it.”
The rep said it’s not unheard of for Medicaid patients to have to do their annual review every other month. From April 2023 to April 2024, we had four reviews. In each case, Ruth Ellen had to spend her days off going into the Medicaid office to wait in line and turn in her paperwork.
They told us during the review in spring 2024 that we would lose our coverage in July due to making too much money. So we purchased private insurance. But then two months later, Medicaid reached back out and told us the entire family except for me was approved. And they backdated it to include the two months for which we had purchased private insurance. Then around the beginning of October, we were told Ruth Ellen’s coverage would be dropped in December. But then they dropped it at the end of October. In addition to causing us stress, it’s also causing stress for Ruth Ellen’s human resources department who keep having to start and stop our private insurance due to the whims of Medicaid. Meanwhile, Ruth Ellen is in talks with a Medicaid cancer department to see if she can get covered for cancer.
Despite being cancer free, she has to receive a number of monthly, ongoing preventative treatments and hopefully no additional unexpected surgeries to keep cancer from returning.
Waste, fraud and abuse
Women who are going through cancer treatments shouldn’t have to spend this amount of energy dealing with total incompetency and then having to hire criminal defense attorneys.
I agree the Medicaid system is filled with waste, fraud and abuse. But it’s not the women who are undergoing cancer treatments who are the problem. The problem is the politicians who set up this ridiculous system, underfund it, and then puff out their chests going after people in the name of justice.
And it feels to us like they are making Medicaid patients jump through endless hoops like circus animals in hopes many of us will just give up and lose coverage.
As a former conservative, I understand the impulse to read this story as an example of why the government shouldn’t be trusted to handle our health care. It’s been a bureaucratic nightmare for us. But the solution isn’t to cut millions of people off Medicaid in the name of cutting waste, fraud and abuse. The solution isn’t to make cancer patients fend for themselves against an insurance industry in an economy none of us can face alone.
The solution is to create a system that actually works, that demonstrates a basic level of common sense, that is well funded.
If President Trump were to take seriously making this system better for women who are undergoing cancer treatments, then I would be the first to sign on to that bill. Until then, I’ll have to settle for rolling my eyes and hoping not to end up in prison for a decade while wasting time in appeals processes whenever a letter comes in the mail that asks our 7-year-old to show proof of our 11-year-old’s income.
While we were able to scrape funds together to hire a lawyer, how many people in South Carolina are unable to do so? And how many of them, out of fear, on top of losing their health insurance, end up signing these $25,000 plea bargains?
Rick Pidcock is a 2004 graduate of Bob Jones University, with a bachelor of arts degree in Bible. He’s a freelance writer based in South Carolina and a former Clemons Fellow with BNG. He completed a master of arts degree in worship from Northern Seminary. He is a stay-at-home father of five children and produces music under the artist name Provoke Wonder. Follow his blog at www.rickpidcock.com.