Yet Another Tennessee Nursing Facility Charges Medicaid for Items Not Allowed


Officials with the Bledsoe County Nursing Home in Pikeville improperly billed Medicaid more than $50,000 for nearly a year — while operating below 85 percent capacity.

This, according to a new audit Tennessee Comptrollers recently released.

Those same officials spent nearly $6,000 of that money on basic haircuts, shampoos, and beard trims, auditors went on to say.

“Bledsoe County Nursing Home should not accumulate or bill the Medicaid Program for hospital or therapeutic leave days when the facility is operating below 85 percent occupancy or when residents’ leave days exceed 10 per state fiscal year,” Comptrollers wrote.

“As a result of the billing for 332 non-covered resident days, the facility should file corrected claims for these days, which will result in a refund of $51,964.69 to the State of Tennessee Medicaid Program.”

In a statement, nursing home managers said they concur with the Comptrollers’ findings and would fill corrected claims.

As The Tennessee Star reported earlier this month, in two separate audits, Comptrollers called out staff at The Bridge at Highland in Portland, Tenn. and Signature HealthCare of Putnam County in Cookeville for similar problems.

Bridge at Highland staff included a combined $60,724.24 of non-allowable expenses on four consecutive Medicaid reports between 2012, through 2015, Comptrollers said.

“Of the non-allowable expenses, a four-year total of $33,788.62 was for wastewater and plant maintenance equipment expense for Highland Academy, a school that owns and shares the physical property upon which this nursing facility is located,” according to the audit.

“SP Environmental Specialty is the company that maintains wastewater and plant equipment for the nursing home and Highland Academy. The Bridge at Portland and Highland Academy receive separate regular invoices from SP Environmental Specialty for the services rendered to each entity. However, Highland Academy also bills the nursing home for half of its invoice.”

Remaining non-allowable expenses include those for gift cards, marketing, and alcohol use, according to the audit.

Signature HealthCare staff, meanwhile, had $28,903 in non-allowable expenses for a Medicaid cost report in 2015, auditors wrote.

As reported in August, Tennessee taxpayers lost more than $3 million after a corporate-run nursing facility billed the state that much money for expenses not covered under Medicaid.

That corporation, AltaCare, is based out of Alpharetta, Georgia.

As The Tennessee Star reported, employees at an Oak Ridge health care facility billed Medicaid more than $25,000 for items that Medicaid wasn’t supposed to cover.

As also reported that 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. Also, 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 [email protected]
Photo “Bledsoe County Nursing Home” by Bledsoe Co. Nursing Home Activities & Crafts.




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