Taylor Reports Fayette County Nursing Facility May Owe State Nearly $100,000

Thursday, November 15, 2007

Fayette County -

Auditor of State Mary Taylor released a Medicaid provider audit for a Fayette County nursing facility today. The audit of THI of Ohio at Auburn Manor indicates the provider incorrectly billed the Ohio Department of Job and Family Services (ODJFS) more than $95,000 for room and board and therapy services.

“The failure to properly review billing statements submitted to the state for Medicaid services increases the potential for misspending and could jeopardize the funding of a program serving some of the state’s most vulnerable citizens”, Taylor said.  “I encourage THI’s management to review their billing systems and practices to prevent these types of mistakes in the future.”

The total amount Auburn Manor may owe the state is $95,663.68. The audit reveals that several claims for room and board and therapy services filed by Auburn Manor for reimbursement contained billing errors. The errors include:

  • Certain claims paid at 100 percent that should have been reimbursed at 50 percent
  • Claims that should have been charged to Medicare instead of Medicaid
  • Claims that should have been charged to private insurance companies rather than Medicaid
  • Therapy claims that lacked proper documentation

The audit reviewed Medicaid reimbursements made to Auburn Manor from July 1, 2004 through June 30, 2005 for room and board as well as therapy services. During this period, Auburn Manor was reimbursed $2,565,507.76 for 628 monthly Medicaid claims for 92 patients.

According to the audit, nursing home facilities account for 22 percent of all Medicaid expenditures making it the number one category of Medicaid expenses. Prescription drugs, the second largest expenditure category, account for 17 percent of Ohio’s Medicaid expenditures.

Taylor has referred the findings to the Ohio Department of Job and Family Services.  As the state agency charged with administering the Medicaid program in Ohio, it is the responsibility of ODJFS to make any final determinations regarding recovery.  Under Ohio law, amounts due to the state must be paid within 45 days of a determination, after which time the matter is referred to the Ohio Attorney General for collection.

In 2005, Taylor sponsored legislation in the Ohio House of Representatives granting the State Auditor the discretionary authority to audit individual Medicaid providers.  Medicaid provides health coverage to low income families, children, pregnant women, and people who are aged, blind, or have disabilities.  Medicaid is administered by ODJFS.

The Ohio Auditor of State’s Office is one of the largest accounting offices in the nation.  The office strives to ensure that all public funds are spent legally and appropriately and works aggressively to root out fraud, waste and abuse in public spending. Taylor encourages anyone suspecting fraud or misspending of public dollars to contact her office toll free at 1-866-FRAUD-OH (1-866-372-8364).

A full copy of the audit is available online at www.auditor.state.oh.us.