West Tennessee Health Clinic Overpaid $4.7 Million by TennCare
Grove Primary Care Clinic, LLC now under investigation
An examination by the Tennessee Comptroller’s Office has revealed that Grove Primary Care Clinic, LLC did not accurately report information to the state when seeking TennCare reimbursements, which resulted in TennCare overpayments of $4,705,641.
Grove Primary Care operated clinics in Henderson, Middleton, and Scotts Hill. Comptroller auditors contacted clinic owners on October 30, 2019 about their examination, and all three facilities abruptly closed the next day.
Auditors reviewed quarterly invoices submitted by Grove Primary Care to the state from January 2014 through June 2019. The invoices included the number of patient visits to the clinics for TennCare services and the amounts received for those services that were paid by Managed Care Organizations, third parties, and patients. These invoices are used to process reimbursements.
The examination found that, whether due to fraud or error, Grove Primary Care overreported 44,342 patient visits and overreported $2,213,082 in payments received from MCOs, third parties, and patients. The inflated number of patient visits resulted in TennCare’s overpayment of more than $4.7 million in reimbursements to Grove Primary Care.
Grove Primary Care is obligated to return overpayments and may be subject to liability under the federal False Claims Act, which could trigger a fine and triple the amount of damages, known as “treble damages,” if owners conceal or knowingly and improperly avoid or decrease an obligation to pay money to the federal government.
Grove Primary Care is also currently being investigated by the Tennessee Attorney General’s Office for violation of the Tennessee Medicaid False Claims Act.
The Tennessee Comptroller’s Office is authorized to perform examinations of certain Rural Health Clinics, such as Grove Primary Care, LLC, under the terms of a contract with the Tennessee Department of Finance & Administration.
