State auditors say the Bledsoe County Nursing Home in Pikeville, Tennessee, improperly billed Medicaid almost $52,000 for resident leave days, and inappropriately billed 76 nursing home patients more than $5,800 combined for basic haircuts, shampoos and beard trims.
The examination covered the period between July 1, 2014, and June 30, 2018, for the review of Medicaid days, and the period between July 1, 2014, and April 8, 2019, for resident accounts, according to a Tennessee Comptroller of the Treasury Medicaid Examination released this month. Auditors notes the facility hasn't been examined in the past five years.
Bledsoe County Nursing Home is owned and managed by the county. Nursing home officials acknowledge the findings and spell out corrective actions in "Management responses" included in audit documents.
Related to Medicaid billing, the nursing home "improperly billed the Medicaid Program $51,964.69 for 332 days while operating below 85% capacity," the audit states. "Of this amount, $19,810.57 was for 124 days for the fiscal year ended June 30, 2015; $15,491.18 for 101 days for the fiscal year ended June 30, 2016; $8,796.39 for 56 days for the fiscal year ended June 30, 2017; and $7,866.55 for 51 days for the fiscal year ended June 30, 2018 for hospital and therapeutic leave days while operating below 85% capacity."
Patient leave days are defined as periods when a Medicaid resident is hospitalized or absent for therapy. According to documents, Medicaid shouldn't be billed for leave days when the facility is below 85% capacity, which auditors say happened during the period of the examination.
A change regarding Medicaid's 85% capacity rule occurred during the period examined creating a situation for the error, Sharon Holliday said Monday. The state recommended the facility file corrected claims for the period and refund Medicaid the amount involved, which nursing home officials said would be done.
Related to charges for Medicaid covered grooming services, auditors said 76 Medicaid residents were inappropriately charged for the services from July 1, 2014, to April 8, 2019, totalling $5,881.
State officials said the nursing home shouldn't bill Medicaid patients for covered services and recommended full reimbursement and that the facility not charge for such services in the future.
Nursing home officials agreed not to charge for covered services in the future "unless the resident has requested that the beautician perform these services for them."
"The facility has developed a form that residents or their representatives will sign if they request and prefer to have beautician services," facility officials said, noting the 76 residents involved will be reimbursed.
Contact Ben Benton at bbenton@timesfreepress.com or 423-757-6569. Follow him on Twitter @BenBenton or at www.facebook.com/benbenton1.