The Tennessee Comptroller's Office released a report this week with two recommendations that a Monteagle, Tenn., nursing home refund almost $80,000 to resident families and to the Medicaid program.
The state's recommendations for refunds, based on a review of records from 2014 and 2015, were issued amid findings that the facility was overpaid more than $76,000 in Medicaid reimbursements and didn't return about $2,800 in patient credit balances.
The Bridge at Monteagle - owned and operated by LP Monteagle LLC in Louisville, Ky. - was the subject of a state audit covering the period Jan. 1, 2014, through Dec. 31, 2014; resident days for the period Jan. 1, 2014 through June 30, 2015; and resident accounts for the period Oct. 1, 2014, through Sept. 30, 2015, according to the Comptroller's Office report issued on Tuesday.
Since the time field work was done in the report, facility management addressed the three findings, officials said.
The current CEO of The Bridge at Monteagle did not work for the facility at the time of the audit and did not wish to comment.
In a Oct. 29, 2015 report,comptroller's office director Deborah V. Loveless stated that aside from the three findings, The Bridge at Monteagle complied with requirements.
A previous finding in a report for the period Jan. 1, 2009, through Dec. 31, 2011, for $1,613.94 owed to the state's Medicaid program for improper billing of resident hospital leave days was repeated in the latest audit.
State officials in the 2014-2015 audit found the mountain top nursing home had almost $49,927.66 in non-allowable expenses on the Medicaid cost report that caused $76,854.42 in overpayments for the year ended Dec. 31, 2014. The non-allowable expenses included $43,987 in marketing-related expenses and the remainder in expenses unrelated to resident care, therapy expenses that were not related to the appropriate level resident care, other unsupported expenses and late fees.
That finding was addressed with changes, according to the report.
"[W]e have altered our preparation process to offset applicable marketing personnel," management's response states. "We will review the other findings and incorporate any changes necessary to comply with applicable regulations."
In the finding on patient credit balances, management responded that the facility's policy is to issue "timely refunds," but that officials' first attempt to work with insurance companies to "get the insurance to recoup the funds overpaid."
The facility issues a refund if the insurance company does not recoup.
"The credit balances that were reviewed have since been refunded to the appropriate payer," facility management states.
In the third finding, state officials found six facility residents with trust fund balances exceeding the Medicaid resource limit of $2,000, making them ineligible. The limit is based on the Social Security income limit.
State officials said the facility should notify each resident or their family when any resident's funds approach the limit.
Management responded that residents are notified when their trust fund account comes within $200 of the limit.
That policy "provides the resident or the resident's family with ample time to 'spend down the resident's resources," management states. "Balances found during the audit were spent down for each resident's needs."
Contact staff writer Ben Benton at bbenton@timesfreepress.com or 423-757-6569.