A west Tennessee primary care clinic overcharged TennCare — and, by extension, taxpayers — more than $4.7 million, according to an audit that Tennessee Comptrollers published late last week.
Officials who oversaw that company, the Grove Primary Care Clinic, closed all three of their facilities in 2019. They did this one day after state auditors announced they would examine the company’s finances.
TennCare is the state’s Medicaid program. TennCare allows Tennessee officials to deviate from certain federal Medicaid policies.
“The examination found that, whether due to fraud or error, Grove Primary Care overreported 44,342 patient visits and over reported $2,213,082 in payments received from MCOs, third parties, and patients. The inflated number of patient visits resulted in TennCare’s overpayment of more than $4.7 million in reimbursements to Grove Primary Care,” according to an emailed press release.
“Grove Primary Care is obligated to return overpayments and may be subject to liability under the federal False Claims Act, which could trigger a fine and triple the amount of damages, known as ‘treble damages,’ if owners conceal or knowingly and improperly avoid or decrease an obligation to pay money to the federal government.”
Grove Primary Care operated clinics in Henderson, Middleton, and Scotts Hill, according to the press release.
Authorities have reported massive waste, fraud, or abuse involving TennCare or Medicaid for several years.
In 2020, for example, authorities indicted the former Controller of a TennCare-funded facility in Sweetwater for allegedly stealing nearly $120,000. Also, last year, Comptrollers said that the former chief operating officer of a taxpayer-funded clinic in Lebanon allegedly stole more than half a million dollars.
Tennessee Comptrollers in 2019 said staff members at two health care facilities in Portland and Cookeville billed Medicaid for a lot more than legally allowed. Also that year, Comptrollers said TennCare overpaid more than $600,000 to a now-closed health care clinic in Madisonville.
In 2018, a state audit said TennCare gave out more than $700,000 to duplicate members and also to people who were already dead or incarcerated. Those recipients were ineligible to receive TennCare money.
In 2019 the U.S. Government Accountability office said the federal government wasted almost $12 billion taxpayer dollars on people nationwide who took Medicaid — but weren’t eligible.
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Chris Butler is an investigative journalist at The Tennessee Star. Follow Chris on Facebook. Email tips to [email protected].
Photo “Doctor Greeting Patient” by Vic. CC BY 2.0.
TennCare – the big slush fund for thieves. And people actually want to expand TennCare?
Is no one overseeing this stuff in the near time? It seems that it is always 2,3 4 years after the fact. Is any of this money actually ever recovered? I doubt it. Big government in action, or should I say big government inaction?
There wasn’t a certain State Senator involved with this clinic, was there?
And to think, this is just a small clinic and the state of TN. You know the larger corporate medical conglomerates have been doing the same thing to larger insurance companies for decades, which has driven up the cost of insurance to the point where the self-employed cash customer can barely afford it. Even worse, when they find out you’re a cash customer, you’re treated like some vagrant and not given the same level of care as someone with a Blue Cross Blue Shield Cadillac plan.
Before insurance took over, doctors used to charge you based on a percentage of your income. The system is broken…very broken.