Tennessee Comptrollers say staff members at two health care facilities in the state billed Medicaid for a lot more than legally allowed, and taxpayers lost money as a result.
In two separate audits released Tuesday, Comptrollers called out staff at The Bridge at Highland in Portland, Tenn. and Signature HealthCare of Putnam County in Cookeville.
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.
No one at The Bridge at Highland returned The Tennessee Star’s request for comment Tuesday.
Signature HealthCare staff, meanwhile, had $28,903 in non-allowable expenses for a Medicaid cost report in 2015, auditors wrote.
“The non-allowable amount included $21,015 in marketing salaries; $6,703 in marketing expenses; $642 in unsupported expenses; $310 in therapy expenses; and $233 in expenses the home office allocated to the facility in error,” Comptrollers wrote.
Signature HealthCare’s administrator promised The Star an emailed response to the audit, but as of Tuesday night, his email did not come.
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.
– – –
Chris Butler is an investigative journalist at The Tennessee Star. Follow Chris on Facebook. Email tips to [email protected].
[…] Tennessee Star reported last month, Tennessee Comptrollers said staff members at two other health care facilities in the state billed […]
[…] The Tennessee Star reported last month, Tennessee Comptrollers said staff members at two health care facilities in the state billed […]
[…] The Tennessee Star reported earlier this month, in two separate audits, Comptrollers called out staff at The Bridge at Highland […]
So was this part of a cost report? How did they include these monies on a 1500 or UB-04 claim? Those forms have no place for such billing This is really not a clear article. Remember you have, in this city, lots of healthcare professionals who will read this and think the person who wrote it doesn’t understand the entire situation enough to understand what went on and write a clear article about it Cost reports are extremely technical and not a lot of people understand them in any detail. They are sort of like IRS reports where it gets a little squirmy as to what is deductible or not and with cost reports, what can be included or not. Is that the problem here? Cannot really tell much about what is going on here, how it happened or why. Maybe the info isn’t even accurate. Cannot know from this.
One would assume that businesses sucking up government money would have employees that could actually fill out the required forms properly…. or hire a company to do so. Confusion on the providers part is not an excuse.
I agree with Ms. Martha but I would also have to ask “So what?”…Article includes nothing about any cure to the malady…..Incompetence in these types of activities is not rare but finding a remedy always seems to be too hard….