Tennessee AG Alleges Care Services Management in State Committed Medicaid Fraud

 

Tennessee Attorney General Herbert Slatery this week announced a lawsuit against the Murfreesboro-based Care Services Management and Marquis Mobile Dental Services for allegedly wasting taxpayer money and allegedly violating the Tennessee Medicaid False Claims Act.

This, according to an emailed press release that Slatery and his staff emailed this month.

“In the complaint, the state alleges Mark Napper, through his health services management organization, knowingly caused false claims to be submitted under the state’s Medicaid program, TennCare. The state asserts defendants focused on Tennesseans who were receiving Medicaid assistance for their long-term care and were eligible to deduct healthcare expenses, like dental care, from the payment to their long-term care (LTC) facility.  Those deductions resulted in TennCare paying for a larger portion of the long-term care,” according to the press release.

“Defendants provided free administrative services to the LTC facilities and free dental services for some of their residents. In exchange, the LTC facilities referred patients to CSM.  This constituted an illegal kickback arrangement. A second violation occurred when CSM referred those same residents to mobile providers in return for cash.”

The lawsuit said these actions violate the federal Anti-Kickback Statute, which in turn violates the Tennessee Medicaid False Claims Act, Slatery’s press release said.

“The state is seeking damages to be determined at trial, in addition to the maximum civil penalty for each violation,” according to the press release.

Napper’s attorney Gary Blackburn told The Tennessee Star Tuesday that his client did not break the law.

“This program involves not one red cent of money of the United States or the state of Tennessee. This is a program for dental care for long-term care nursing home facility residents. Federal law requires nursing homes to facilitate provision of care. How do you do that? Or provide the transportation? Their alternative to some program like my clients would be to hire a full-time dentist. That is obviously not practical. Who is supposed to pay for it? Because the nursing home has no obligation to pay for the dental care, and TennCare and Medicaid has no obligation to pay for it,” Blackburn said.

“The next would be to carry these people to dentists. How time consuming and expensive is that? These are elderly people. So a number of years ago my clients came up with this mobile dentistry idea so they call upon these nursing homes, and they provide this service. Here is how it’s paid. There is a provision recognized by both state and federal law in which you set up a trust account for the nursing home residents’ funds. That is placed in a trust, and certain expenses are paid out of that.”

Blackburn said that “never more than the funds that the patient is receiving are charged.”

“Where could there conceivably be a kickback? What you will notice in this complaint is the irresponsible use of language. Kickbacks. First, the state of Tennessee is not here to recover any federal funds because the United States has declined to do that nor are any federal funds spent charged, or received. What next?” Blackburn asked.

“It is conceivable that at some point if these patients are healthy and kept healthy that they might actually incur a condition that did require Medicaid reimbursement. I am not kidding you on this. Their theory literally is that healthier patients can lead to greater expense and therefore that somehow constitutes a kickback from a nursing home for allowing these people merely to see a dentist. I know that sounds ridiculous.”

– – –

Chris Butler is an investigative journalist at The Tennessee Star. Follow Chris on Facebook. Email tips to [email protected]

 

 

 

 

 

 

Related posts

Comments