TennCare reportedly overpaid nearly $300,000 of taxpayer money to a Shelbyville physician who said state officials don’t do much to help rural doctors comply with Medicaid requirements, according to a report that Tennessee Comptrollers released Thursday.
The report cited Joseph Howard Rupard for failing to accurately report TennCare visits and payments submitted to the state of Tennessee.
TennCare is the state’s Medicaid program. TennCare allows Tennessee officials to deviate from certain federal Medicaid policies. Authorities have reported incidents of massive waste, fraud, or abuse involving TennCare or Medicaid for several years.
Rupard provides rural health clinic services and participates in Tennessee’s Medicaid Prospective Payment System, Comptrollers wrote in Thursday’s report.
Members of Rupard’s staff told The Tennessee Star on Thursday that they knew nothing about the Comptroller’s report and that neither they nor the doctor would comment.
But in Thursday’s Comptrollers’ report, Rupard’s management team said government officials did not specify what does and does not constitute a TennCare visit.
“TennCare has provided little to no guidance or training to rural health clinics with respect to the calculation of visits or preparation and submission of cost reports,” members of Rupard’s management team wrote.
“Once a cost report is submitted, providers like Dr. Rupard also have no meaningful way to access or review TennCare’s visit data to determine whether the number of visits listed in their cost reports is consistent with TennCare’s visit data. And yet, TennCare and its auditors seemingly expect perfection from providers and impose stiff penalties on those who fail to correctly ascertain, interpret, or apply TennCare’s prolix and intricate reporting requirements.”
Comptrollers reported last month that a west Tennessee primary care clinic overcharged TennCare more than $4.7 million.
In 2020, 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 “Dr. Joseph Howard Rupard” by Dr. Joseph Howard Rupard.
Dr. Rupard is a great Doctor and person, I have been going to him and his PA since they came to Bedford County 30 + years ago. He cares for so many patients in this county and I know he’s a very caring, honest person. Tenncare was a very good program when it first started and politicians have ruined it for the patients and providers.
Just another reason to terminate TennCare.
If the medical insurance industry would simply implode, that would be a great first start to fixing things. Remember when all of the insurance companies abandoned their customers and jumped aboard the ObamaCare train? When they realized they weren’t going to make the billions of dollars they thought they would (because Obama/Pelosi lied to us all), they left the exchange, leaving only a couple of bottom feeders to choose from. I have no pity for them.
Back on topic. Fraud is built into the business model. It’s designed that way intentionally, as long as it is the customer who is getting ripped off. The doctors, hospitals, and insurance companies don’t care as long as they are getting paid. But once one of them loses some money, a big bad fraud investigation is opened up.
So….. Repeal and Replace….where is it Marsha? Remember the promise? Oh that’s right, it never existed!
Dr. Rupard is correct. There is very little direction , instruction, or anything else to help interpret the very gray explanations on what constitutes a billable service. The government loves to swoop in and do “gotchas”, where they audit everybody, ruin their careers, and bankrupt them. Meanwhile, the “medical welfare system” remains broken.
Cherokee Health over billed TennCare more than 7 million dollars. You of course won’t hear that in the Comptrollers report. They entered into a sweet repayment plan that allowed them over four more years than specified in the state statute to make restitution, and no fines were imposed. They operate on tax dollars to start with, why are taxpayers having to pay themselves back. TennCare should have gone after those responsible. Even Amerigroup got their money sooner.