A recent audit of Tennessee Medicare found that of the $2 billion in certified public expenditures it claimed during the audit period of 2009 to 2014, $909.4 million was allowable while $1.1 billion was not.
The amount includes $482.1 million of excess certified public expenditures TennCare allegedly claimed but did not return after calculating the actual expenditures.
The HHS' Office of Inspector General is recommending that TennCare:
- Refund $397.4 million in alleged overpayments to the federal government
- Provide support or refund the federal government $370.1 million for the net costs of caring for uninsured patients being treated at institutions for mental diseases allegedly without providing the correct documentation
- Create additional policies and procedures to make sure it complies with the federal requirements
TennCare objected to the first and second recommendations but agreed to the third. TennCare Director Stephen Smith told WPLN that he plans to appeal the findings if necessary.
"We're going to actively refute the OIG findings," Mr. Smith said. "We're going to take all necessary steps in appeals to avoid any unwarranted repayment."