TennCare gave out more than $700,000 to duplicate members and also to people who were already dead or incarcerated, according to a new state audit.
All of those recipients were ineligible to receive TennCare money.
The findings, released late last week, cover July 2016 through December 2017. Generally, TennCare must refund the federal share of Medicaid overpayments to the Centers for Medicare and Medicaid Services, auditors wrote.
“TennCare should investigate providers who billed for services that took place after a member’s date of death or during a member’s incarceration to determine if fraud occurred,” auditors wrote.
As for people in prison, auditors said “TennCare should work with the Tennessee Department of Correction and its incarceration data contractor to establish a more effective process for identifying and verifying TennCare members who are incarcerated and suspending those members immediately.”
TennCare, auditors went on to say, should also retroactively recoup any payments made on behalf of incarcerated TennCare members.
TennCare officials should weed out payments made to members with multiple TennCare identification numbers, auditors wrote.
In a written response to auditors, TennCare officials said they concur with some of the findings.
TennCare officials, though, said they disagreed with Comptrollers’ findings on payments to people in prison.
“We will continue to encourage improvements in correctional data quality, though we have no direct control over the collection of this data, and we will consider changes to the process at some point in the future if we develop greater confidence in the quality of the data,” TennCare officials wrote.
TennCare officials also did not agree with auditors’ findings on duplicate members.
“TennCare receives eligibility data from multiple sources, and it takes time to process changes to the MMIS eligibility data and match the criteria to determine if enrollees are truly duplicates or not,” TennCare officials wrote.
“Our MCO capitation process performs a monthly nine-month lookback as well as a quarterly five-year lookback to determine if we made improper payments for duplicate enrollees and take corrective action, if necessary.”
The U.S. Department of Health and Human Services’ Office of Inspector General published an audit report in December 2017. That audit said TennCare made an estimated $2.7 million in improper capitation payments for deceased members during the period July 1, 2009, through March 4, 2016.
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