by Jon Styf
A recently released audit shows the Hall Medical Clinic in Waynesboro received more than $300,000 in TennCare funding payments due to underreporting the payments the clinic received.
In an audit conducted by the Tennessee Comptroller’s Office, the clinic was found to have not reported $621,775 in payments and 2,340 TennCare visits to the clinic between 2017 and 2021.
The clinic used a system that pulled specific office procedure codes but did not record laboratory or radiology services payments. Those payments came from managed-care organizations, third parties and patients.
The auditors also found eligible visits such as nursing home, assisted living, home care and office visits were not recorded.
Each quarter, clinics report the number of visits, services and payments it receives and files it with TennCare in a process that results in reimbursement of some of those funds.
In determining how much TennCare had overpaid the Hall Medical Clinic, it subtracted the value of those unreported visits from the amount of underreported payments and found that the difference was $307,935 in overpayments from TennCare.
“There was no intent to report inaccurate revenue amounts on the part of previous ownership and/or management or the Hall Medical Clinic during the relevant time period,” the clinic said in response to the finding.
The clinic was owned by Joe Hall until he died in November 2020. Ownership was then transferred to his daughter, Valerie Hall-Glass, in October 2021.
“The clinic has reviewed its standards and procedures for reporting revenue on quarterly reports and is now reporting revenue accurately,” it said in its response to the audit.
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Jon Styf is an award-winning editor and reporter who has worked in Illinois, Texas, Wisconsin, Florida and Michigan in local newsrooms over the past 20 years, working for Shaw Media, Hearst and several other companies. Styf is a reporter for The Center Square.
Photo “Doctor and Patient” by MART PRODUCTION.
Just another of an infinite number of examples why Medicaid by any other name needs to be shutdown. Millions and millions in welfare in the guise of medical care. A goodly portion of which is fraudulently collected.
Medical billing code is a dark and murky place, just ask Cherokee Health about how to improperly bill TennCare millions of dollars..