Home » State Audit Reveals TennCare Overpayment at Hall Medical Clinic

State Audit Reveals TennCare Overpayment at Hall Medical Clinic

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The Division of State Audit recently released a TennCare examination of Hall Medical Clinic in Waynesboro, Tennessee. According to the Tennessee Comptroller of the Treasury, the Division of State Audit performs examinations of Rural Health Clinics (RHCs) participating in the Tennessee Medical Assistance Program under Title XIX of the Social Security Act. The examination is a report of TennCare visits and payments of Hall Medical Clinic for the period of January 1, 2017, through December 31, 2021.

The audit resulted in one finding. The report states, “Hall Medical did not accurately report payments and visits for TennCare services on its submitted quarterly settlement requests, which resulted in a TennCare overpayment of $307,935.” The report noted that this overpayment amount was for the period of January 1, 2017 through December 31, 2021.

Hall Medical Clinic provides Rural Health Clinic services and participates in Tennessee’s Medicaid Prospective Payment System. The clinic owner during most of the examination period was Joe I. Hall, MD. Dr. Hall passed away on November 12, 2020. The clinic was then transferred to Valerie Hall Glass, FNP, daughter of Dr. Joe Hall, in October 2021.

While reviewing the TennCare claims data for the selected quarters, the auditors determined that the clinic omitted some eligible visits from the payment requests. In simpler terms, $313,840 that was mistakenly NOT billed to TennCare amounted to money that the clinic was owed but did not bill for nor receive.

The recommendation in the audit report for resolution of the issue stated, “Hall Medical Clinic should establish procedures to ensure that it submits accurate quarterly settlement requests to the State of Tennessee. The requests should reflect the actual paid TennCare visits and all monies received for TennCare services for each quarter reported. Upon the Division of TennCare’s approval, State Audit will reprocess all quarterly settlements and transmit them to TennCare for recoupment of the overpayment.” This means that the overpayments made by TennCare to the clinic will be reprocessed, and TennCare will recoup the entire amount of the overpayment.

Hall Medical Clinic’s response to the Division of the State Audit said, in part, “Errors, if any, regarding ancillary services or quarterly reports submitted by previous management between January 1, 2017, and December 31, 2021, are the inadvertent result of errors in billing software utilized by the clinic for all or part of the time period as well as inconsistency in reporting requirements for various programs. There was no intent to report inaccurate revenue amounts on the part of previous ownership and/or management of the Hall Medical Clinic during the relevant time period. The clinic is now reporting revenue accurately. The absence of any intent to report inaccurate information on the quarterly reports is demonstrated by the fact that those reports underreported patient visits, which resulted in less revenue being paid out under the RHC program.”

Essentially, the error in the billing software resulted in both overpayment received from TennCare, along with money that TennCare did actually owe the clinic that was not billed for.

Valerie Hall-Glass, FNP, confirmed that all the findings made to the clinic were from TennCare, and no other insurances nor patients were billed incorrectly. She said that Hall Medical is the only rural health-accredited clinic in Waynesboro, and it is common practice for all rural health clinics to be audited by the State.

“This situation was the unfortunate and costly result of an issue with our billing software,” said Hall-Glass. “My dad had absolutely no idea of this when he was the owner of the clinic. We are doing everything asked by the Audit Division to make sure the problem has been corrected, and the money will be paid back to TennCare in a timely manner.”

Hall-Glass went on to say, “We want to assure our patients that we are still here, still open, and will continue to meet their healthcare needs. The findings of the audit have certainly been unsettling to us, as we were unaware of the issue and have done everything to correct it. We ask that our patients find understanding for us, and remain confident in our ability to take care of them.”

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