TennCare Improperly Paid for Care of Ineligible Individuals, Audit Says
TennCare, Tennessee's Medicaid managed care program, last year inappropriately spent money on health services for inmates, out-of-state beneficiaries and people covered by other health plans, an annual audit by the state Office of Comptroller found, the Nashville Tennessean reports. Between July 1, 2000, and June 30, 2001 -- the time covered by the audit -- TennCare paid $7 million to provide care to inmates, even though the state is separately responsible for such costs. The audit also found that TennCare spent $48 million on health services for individuals who did not live in Tennessee, and $465 million on services for beneficiaries whose eligibility could not be confirmed because they listed P.O. box addresses on their applications instead of a street address. TennCare spokesperson Lola Potter said the program is responsible for some health costs of out-of-state beneficiaries, including college students and residents seeking services outside of Tennessee. The program has removed 1,782 ineligible out-of-state beneficiaries since July, Potter added. The audit also found that some individuals were able to enroll in TennCare twice, leading the program to make double payments to managed care organizations. Further, TennCare paid about $2 million to the state Department of Children's Services to provide health care, even though MCOs already had been paid to provide the services. TennCare also spent more than $700,000 to enroll state employees, who "should have had access to private insurance," the Tennessean reports. The state has had problems ensuring that it is properly spending program money in part because of a computer system that was purchased in the 1970s. A new system is scheduled to be in place by October 2003. TennCare officials also intend to reverify the eligibility of 40,000 beneficiaries per month (Lewis, Nashville Tennessean, 4/25). The audit is available online.
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