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UPDATE NOV. 2: Unity’s response

The state concluded a routine audit in July 2019 of TennCare payments to Unity’s two rural health clinic for the service period from January 2014 through June 2019, said Chief Executive Officer of Unity Medical Center Martha McCormick.

“Unity found the audit to be helpful in identifying a weakness in a process that was believed to be accurate,” McCormick said. “The audit revealed that one of the TennCare payors was comingling TennCare visits and Medicare Advantage visits on the same report. Unity relied on the TennCare reports to submit patient visits to the state. The TennCare report sometimes overreported and sometimes underreported eligible TennCare visits. On balance, the process resulted in over reporting eligible TennCare clinic visits. It is important to understand that Unity did not over report the total number of patient visits at either clinic. The auditors did not dispute the number of total visits Unity reported, only that some of these visits should have been paid by Medicare Advantage, not TennCare.

The audit period covered five and a half years, said McCormick.

“During that time, the audit concluded that TennCare had overpaid Unity a little more than $500,000,” she said. “The total overpayment was relatively insignificant and amounted to less than one-half percent of Unity’s total revenue during that time period.

“Once this reporting error was discovered, Unity immediately agreed with the audit findings and changed its process for reporting. Rather than relying on the TennCare reports, Unity has created an internal method of verifying the contractor’s reports to assure accuracy. Unity staff now manually reviews every claim prior to submitting quarterly state reports. To ensure that the new reporting process has corrected the issue, Unity has submitted five subsequent quarterly reports to the state auditors which have been approved and processed for payment as submitted. The audit did not suggest that there was any intent to submit incorrect data and the matter has now been settled with no penalties imposed. It is important to understand that routine audits are performed to ensure accuracy and identify errors on both sides and almost always result in an overpayment or underpayment. The audit served that purpose, and the matter has been corrected. Unity is proud to continue to strive for excellence in delivering healthcare in our community.”

STORY POSTED NOV. 1: On Oct. 28, the Tennessee Comptroller of the Treasury released reports examining the Manchester Rural Health Clinic and the Center for Family Medicine in Manchester, revealing the clinics over-reported visits for the period Jan. 1, 2014, through June 30, 2019. The Manchester Rural Health Clinic and the Center for Family Medicine provide rural health clinic services and are owned and operated by Unity Medical Center.

Pursuant to state law and an agreement  between the Comptroller of the Treasury and the Department of Finance and Administration, the Division  of  State Audit performs examinations  of Rural Health Clinics participating in the Tennessee Medical Assistance Program under Title XIX of the Social Security Act (Medicaid). The reports released Oct. 28 examine TennCare visits and payments of the Rural Health Clinic and the Center for Family Medicine, in Manchester, for the period Jan. 1, 2014 through June 30, 2019.

Finding related to the Rural Health Clinic in Manchester

Manchester Rural Health Clinic failed to accurately report TennCare visits and payments submitted to the State of Tennessee, according to the report. The clinic over-reported 2,864 visits and over-reported $173,824 in  payments  received from Managed Care Organizations  (MCOs),  third  parties, and patients  for  the period Jan. 1, 2014, through June 30, 2019, by including visits for Medicare/Medicaid dual-eligible patients, duplicate visits, and claims that did not meet the Centers for Medicare and Medicaid Services’ definition of a visit. As a result, the Division of TennCare made overpayments of $303,467 to the clinic for the period Jan.  1, 2014, through June 30, 2019, according to the report.

Finding related to the Center for Family Center in Manchester

According to the report, the Center for Family Medicine failed to accurately report TennCare visits and payments submitted to the State of Tennessee. The clinic over-reported 1,681 visits and over-reported   $48,900 in payments received from MCOs, third  parties, and patients for   the period Jan. 1,2014, through June 30, 2019, by including visits for Medicare/Medicaid dual-eligible patients, duplicate visits, and claims that did not meet the Centers for Medicare and Medicaid Services’ definition of a visit. As a result, the Division of TennCare made overpayments of $259,752 to the clinic for the period Jan. 1, 2014, through June 30,2019.

Management’s comment

When the discrepancy was discovered during the audit, management immediately worked to ensure that payments are routinely being posted correctly, implementing an additional reconciliation process that we perform prior to remitting our reports to the state.”

“We continue to work closely with the state and provide detail reports for their review prior to the issuance of any quarterly payments,” management said.

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