The Bureau of TennCare overpaid more than $600,000 to a now-closed health care clinic in Madisonville, according to an audit Tennessee Comptrollers released Monday.
Officials at this facility, the Women’s Wellness and Maternity Center, also over-reported nearly 5,000 paid TennCare visits.
These same officials also under-reported more than $50,000 in payments from managed care organizations, third parties, and patients, auditors wrote.
“For the period January 1, 2012, through June 30, 2017, the examination disclosed a total of 5,824 paid TennCare visits, while the clinic reported 10,543 visits; therefore, the clinic over-reported paid TennCare visits by 4,719,” auditors wrote.
“The examination also disclosed $654,842 in payments from the managed care organizations (MCOs), third parties, and patients for the TennCare visits for the same period, while the clinic had reported $604,766 in payments. The clinic under-reported MCO, third party, and patient payments by $50,076.”
The clinic had other problems.
WWMC staff could not explain how to prepare quarterly invoices before December 2016 and could not complete quarterly invoices for 2017. The facility also had significant turnover of key personnel, auditors wrote.
“They were unable to access the facility’s website because they did not know the password,” according to the audit.
“According to current personnel, there were some electronic health records and billing records they did not have access to due to billing disputes with the vendor. At the time of fieldwork, personnel did not appear to understand the accounting or claims process.”
Invoices, auditors went on to say, often counted prenatal visits twice and failed to report a significant portion of the monies received on delivery services.
An unidentified employee at the Madisonville City Hall told The Tennessee Star Monday that the clinic closed about two years ago for reasons she did not know. But auditors said WWMC closed about a year ago.
WWMC was a nonprofit that operated for about 40 years and was a component unit of the Monroe County government, the audit said. The clinic provided maternity and health care to several thousand low-income women in a rural area, according to the audit.
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