Audit Finds Tennessee Claiming $ 1 Billion Due To Inappropriate Grant Care

Tennessee’s Medicaid program did not qualify for federal claims for uncompensated care in public hospitals as certified government spending, exceeding the authorized claim amount by $ 1.1 billion, according to the data. recent audit…

In a report from the Office of the Inspector General of the Department of Health and Human Services, Tennessee required a total of $ 2 billion in certified government spending during the state’s fiscal years 2009 to 2014. Of this amount, only $ 909.4 million was allowed and supported.

TennCare claimed $ 482.1 million in excess of confirmed government spending, which it did not return after calculating the actual cost of treating Medicaid members and uninsured patients at government hospitals.

“TennCare strongly disputes the findings and consequent recommendations of this federal audit, which clearly points to a flawed federal process,” said Stephen Smith, deputy commissioner and director of TennCare. “TennCare has provided completely acceptable and sufficient information to support the Medicaid claims on which most of the erroneous conclusions are based.”

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It is unwise for OIG to hold TennCare accountable for its operations 12 years ago, he said, because anyone involved with the findings no longer works there.

In January, the Centers for Medicare and Medicaid Services approved the Tennessee Block Grant Waiver Amendment, which provided more administrative flexibility and established funding for its Medicaid program. It was the first state to receive approval of this type of block allocation scheme.

While a federal funding cap could mean less financial risk for Tennessee than upgrading an existing program, pooled savings provisions could also add to the state’s fiscal incentive to cut TennCare’s spending.

After examining Tennessee’s claims from fiscal 2010 to fiscal 2013, OIG found that the state was claiming the same $ 373.8 million each year, leading officials to believe that the specific estimates of certified public spending were not properly calculated.

The agency compared reported government spending with its summary of actual spending for each year, examining the cost of care calculations and other supporting documents.

OIG could only conduct audits until 2014 because this is the last year that Tennessee has calculated actual costs for all of its hospitals, said Lloyd Meyer, a senior auditor with OIG’s Audit Services Authority. The federal government lost more than $ 300 million because the state did not report actual costs.

According to the audit, Tennessee’s confirmed government spending reflects claims of $ 609.4 million in excess of the allowable amount. This includes $ 522.3 million in unsupported net care costs for uninsured mental health patients, $ 53.6 million in unacceptable net care costs for TennCare patients with mental illness aged 21 to 64, and $ 33.5 million in oversized costs. due to incorrect calculations.

OIG recommended that Tennessee reimburse the government for overpayment of $ 397.4 million in over-cost claims, support or recover $ 370.1 million in unsupported net costs of caring for uninsured mental health patients, and develop new policies and procedures to ensure compliance with federal requirements. …

Meyer said OIG will submit the results to the CMS for review.