Audit: Oak Ridge Facility Inappropriately Billed Medicaid Huge Sum of Money

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Employees at an Oak Ridge health care facility billed Medicaid more than $25,000 for items that Medicaid wasn’t supposed to cover.

Members of this facility, NHC Healthcare, also inappropriately included $455,704 of pooled employee benefits on schedule C of the Medicaid supplemental cost report.

All this according to an audit Tennessee Comptrollers released this week.

No one at NHC Healthcare could talk to The Tennessee Star Friday. An unnamed employee said the facility administrator had already left for the day.

“NHC Healthcare Oak Ridge has inappropriately charged Medicaid residents for Medicaid-covered services. From January 1, 2014, through September 25, 2018, the facility inappropriately charged 124 residents a total of $25,436.00 for basic haircuts, shampoos, beard trims, and bang trims,” according to the audit.

As for the other major finding, Comptrollers said employees pooled benefits on the Medicaid Supplemental Cost Report incorrectly.

“NHC Healthcare Oak Ridge included $455,704.00 of pooled employee benefits on schedule C of the Medicaid supplemental cost report for the year ended December 31, 2017, that were already reported as employee benefits on line 3 of the Medicare cost report,” Comptrollers wrote.

“This caused the direct care salaries to be overstated by $455,704.00. The adjustment to allowable expenses had no effect on the facility’s Medicaid reimbursement rate, as this is a non-rebase year.”

As The Star reported last month, the Bureau of TennCare overpaid more than $600,000 to a now-closed health care clinic in Madisonville. 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.

As reported in April, members of a Franklin-based facility, ProHealth Rural Services, Inc., allegedly committed fraud to get $6 million in TennCare benefits to which it was not entitled.

As The Star reported last year, TennCare gave out more than $700,000 to duplicate members and to people who were already dead or incarcerated.

All those recipients were ineligible to receive TennCare money.

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Chris Butler is an investigative journalist at The Tennessee Star. Follow Chris on Facebook. Email tips to
Photo “NHC Oak Ridge” by NHC Oak Ridge.




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