Posted on 04/26/2002 1:15:34 PM PDT by GailA
Millions of TennCare dollars improperly spent
The Associated Press
NASHVILLE -- A new state audit finds that TennCare improperly spent millions of dollars to provide benefits to thousands of potentially ineligible enrollees, including many who don't live in the state or used post office box numbers for their addresses.
The findings are likely to provide more fodder for lawmakers and gubernatorial and legislative candidates who say TennCare must be reformed before taxpayers should be asked for any more money.
But TennCare officials say many of the problems found in the audit, which covered July 1, 2000, to June 30, 2001, have been fixed or are being addressed.
Until December, the state was prevented by court order from removing TennCare recipients from the rolls. Since then, the state has removed 59,000 people and sent another 51,000 enrollees letters saying they will be taken off unless they prove their eligibility.
TennCare is the state's $5.3 billion federal-state health care program for 1.4 million Tennesseans who are Medicaid-eligible, uninsurable due to medical conditions or are uninsured children. It also includes the state's Medicaid nursing home program and supplements state programs for children in state custody, the mentally ill and mentally disabled.
The state Comptroller's audit of the Department of Finance and Administration, which oversees TennCare, listed 47 findings, including "many serious internal control deficiencies that have caused or exacerbated many of the TennCare program's problems."
"For the past seven years, TennCare has failed to implement effective eligibility procedures for uninsured and uninsurable enrollees," said the audit released Thursday. It included many of the findings listed in the state's comprehensive Single Audit Report March 28 to the federal government, as well as problems listed in previous years' audits.
The audit found that TennCare paid more than $48 million during the 2001 fiscal year to cover 19,959 enrollees who did not live in Tennessee -- some with addresses in other countries.
TennCare officials say they are now checking all people with out-of-state addresses to ensure they're properly enrolled -- such as college students or Tennesseans institutionalized in other states. Some 1,727 ineligible non-residents have been removed from the rolls.
During 20001, the program also paid $465 million to insure more than 130,000 people who violated the TennCare bureau's rules and ignored instructions on the TennCare application by listing P.O. boxes instead of street addresses.
TennCare officials say post office box addresses often are used by homeless enrollees, those in mental institutions, children in state custody, people in rural areas without home mail delivery and those under court protective orders.
TennCare director Mark Reynolds said the bureau has since trained workers who determine eligibility to get an address whenever possible.
Additionally, auditors said TennCare also paid almost $7 million to provide health care to people in jail, although the state and not TennCare is responsible for inmates; $750,000 for state employees who have access to state health care benefits; and nearly $2 million in improper benefits for children in state custody.
A new process was implemented in May 2002 to ensure that full-time state workers were removed from TennCare rolls, and some 1,194 state employees and their family members have been dropped since June, officials say.
Auditors also found that fake Social Security numbers were used and some people enrolled twice -- with TennCare making double payments to the managed care companies that manage their care.
Starting July 1, the Department of Human Services in each county will be responsibility for eligibility determination.
One continuing problem is the program's reliance on a computer system that was purchased in the 1970s to run the Medicaid program, which TennCare replaced in 1994.
TennCare officials say they've invited bids on a new system this week and it should be on line by October 2003.
On the Net:
Comptroller's Office: http://www.comptroller.state.tn.us/
TennCare Bureau: www.state.tn.us/tenncare
David Coffey: Nashville struggles -- we steam
Nashville radio personality Steve Gill knows how to lay it on the line. This week he plowed through the just-released TennCare audit for fiscal year 2001. It's not pretty.
Last week he issued an amazingly thorough study of the proposed state budget that has the Legislature in a frenzy. It is eye-popping. Ask me for a copy if you are up to reading "the rest of the story."
Gill points out that those who are pushing for an unconstitutional income tax simply dismiss concern about TennCare, claiming it is a "whipping boy" for the anti-IT folks.
Well, the audit disagrees. It is about an inch thick but available on the Net at:
www.comptroller.state.tn.us/sa/reports/singleaudit0l.pdf
The audit is a scathing indictment of the state's management or mismanagement of TennCare.
For example: "592 full-time state employees were found on TennCare. They were classified as 'uninsured or uninsurable' despite the fact they were eligible for, and in many cases were actually on, state insurance. Cost to taxpayers? Over $700,000. And it appears that not a single one was prosecuted for fraud; nor is there any indication that anyone has been pursued for reimbursement."
That fraudulent waste would pay for the just-canceled Governor's Schools for Tennessee's brightest students. It is maddening to witness great programs being sacrificed in the drive for an unlimited, unconstitutional IT.
And more: The audit reveals "130,767 enrollees have a P.O. box as their only Tennessee address despite the fact that the TennCare application clearly states 'Do NOT list a P.O. box as your home address.' Estimated cost to taxpayers for this group, the vast majority of which are most likely not Tennesseans: $465 million." Gag!
In fairness the audit concedes that some of these "may be appropriately considered residents." But then who knows, with no documentation.
TennCare is available only to "uninsurables" who have been denied insurance by an insurance company. "This system has long been ripe for abuse. The audit notes that 67 percent of insurance agents surveyed issued denial letters based only on the representations of the applicant. In other words, people wanting on TennCare simply had to tell an insurance agent that they are uninsurable in order to get the denial letter making them eligible for TennCare. Think anyone would consider using this massive loophole to fraudulently get free or inexpensive health care?"
Some of the TennCare problems have been resolved since the audit period, but it is notable that many of the audit findings have been repeated year after year.
Any responsible board of directors would raise the roof over such an audit. For TennCare, the Legislature is our board of directors.
Tragically, the Legislature has been distracted by the IT push for ever more money. TennCare smolders; teen smoking leads the nation; bankruptcies and divorces are among the highest in America; pharmaceutical use (abuse) is almost twice the national average. We have problems to solve. Mostly, money is not the answer.
Other states have faced the economic downturn with budget cuts. We seem only to discuss more taxes. California has a budget deficit over $12 billion. That would equal about $2 billion in Tennessee (www.nasbo.org).
Bring on the next administration. We need some relief.
http://www.philvalentine.com/budget02_03.htm Click Here
The following items, in my opinion, don’t need to be funded at this time. That’s not to say that they don’t have merit (some do, some don’t) but when you’re in the middle of a budget crunch you don’t need to be spending money you don’t have.
The Governor’s Reading Initiative Program - $70 million (state portion only) NEW PROGRAM
State Employee Salary Increase of 5% - $49.2 million
ETSU Tennis Facility - $1 million
ETSU Golf Practice Area - $250,000
ETSU Greek Row - $9.2 million
MTSU Greek Row Development Phase II - $17 million
MTSU Observatory Relocation - $500,000
MTSU Recreation Fields Replacement - $4.2 million
MTSU Sports Museum - $1 million
University of Memphis Performing Arts Center - $16 million
University of Memphis University Center Renovations - $22 million
Motlow State Athletic Facilities Lighting Improvements - $320,000
Walters State Agricultural Expo Center - $1 million
Greene County Center Renovations - $5 million
Sevier County Library Construction - $3 million
Sevier County Soccer Facilities - $250,000
UT-Chattanooga College Street Special Housing - $4.4 million
UT-Knoxville Campus Entrance - $2 million
UT-Knoxville Swim Facility - $19.3 million
UT-Knoxville Neyland Thompson Sports Center Addition - $11.6 million
UT-Knoxville Stokely Athletics Center Renovation - $19.4 million
Warriors Path State Park Safety Crossing (actually it’s a golf crossing) - $260,000 (Last year this was ONLY $247,000)
Country Music Hall of Fame Grant – $1 million
Teachers Salary Increase of 2.5% - $40.7 million
Higher Education Salary Increase of 3.5% - $41.4 million
Let's see that's $58M wasted on sports we could cut. Teachers, higher ed and State workers received a 3% pay raise last year. Their combined raises for this year is a whopping $131.3M.
We the Tax Serfs are being asked to take a 4.5% pay cut to fund MORE sports and pay raises for other folks, and the hundreds of Millions of dollars waste and fraud in TennCare...that waste and fraud alone would make up the budget dificit...$480M.
Well, you know, if you good folks would just vote to pass an income tax things like this would never happen. < /sarcasm >
Fight 'em tooth and nail Gail.
Clearly, this method reduces costs significantly, and ought to be adopted by TennCare. The business volume ought to attract several bidders within Tennessee, even if they have to set up a new operation to do it.
They allready pretty much have a bidding system and it's a disaster. The Tenn Care HMO has a pharmacutical mini HMO associated with it or did. I think the state is actually picking up most prescriptions in Tenn Care now. The local Pharmicist does not need to be by-passed. Let's go back to who this was supposed to be for to begin with. Medicaid eligable patients meaning a lot of times ones with long term chronic illness. The services of the local pharmacist is to valueable to loose in these cases and is a cost saver in itself.
I've chased these mini HMO's all over trying to get formulariy list ect. The bidding opens up the Tenn Care system to even more corruption. Tenn Care HMO's recieve kick backs from the pharmucital companies for using their list. I say there should be no formulary list for medications under a certain dollar ammount $75 let's say and the doctors prescription should be filled as written. The cost is coming from doctors having to justify each and every decession they make to HMO's including medications. A person needing a certain blood pressure medication will need it next. It's time also to stop the prior approval nonsense. It's hard enough now taking it to mail order will make it impossible. Besides I really don't want meds delivered to my mailbox.
But the only real answer is to end Tenn Care all together. Restore Medicaid in it's intended form and put it back under the state inspector generals office for oversite. The fact of the matter is too many hands are seeing the health care dollar that are not involved in patient care. Blue Cross and it's HMO allies {leglislators & governor} are running our state into bankruptcy. HMO's must be taken out of the handling {fired} to ever gain back any sensible control over money, services, and eligability. If the state is to have a Medicaid system the state alone should be the ones running it.
I am certain that my old employer does not force me to use the mail service for my convenience, but because it saves them a significant amount of money. (my last refill cost me $122 for a 90-day supply of seven drugs)
In the final year Medicaid purposely started failing and not doing it's task. Doctors got tired of it, suppliers got tired of it, drug stores got tired of it. Then along comes Blue Cross to the rescue. Blue Cross took out full page news paper adds saying Medicaid was broke. Contact your state lawmakers and push for Tenn Care. In the mean time Blue Cross enjoyed the majority of the private sector bussiness in Tennessee private & corporate provided insurance. The doctors were screaming this can not work. Blue Cross in return said either sign on or be taken off our approved physicans list on the private sector. It was there for all to see articles were written on it by papers not running the adds. This is how Tenn Care was born.
Just as with the state income tax the governor of that time and the satate lawmakers thumbed their noses at the state constitution and went against what was right.
Tenn Care was a disaster from the word go. It took months after it was put into place to even get a drugstore list or list of approved doctors from the HMO. The approved drug list changed or there were so many being revised no pharmicist was certain what was what.
In the mean time budget problems showed up and the rolls were said to be needed to be cut. So just who did they try to toss first? The disabled it seems. I would call the HMO to try and see why such and such medication was not covered. They said call the drug store, the drug stores were clueless and said call the doctor, the doctor said call the HMO, the HMO would then connect you to the janitors office in Ohio or somewhere with the desk nerd that was there making life and death decessions on medications in Tennessee. In short doing diagnoses and second guessing doctors without a clue to even their illness. The deliberately set up a run around system to keep you tied up and tired out.
In the meantime HMO's were cutting deals with pharmucital companies that brought in more corruption to the matter. Simular drugs as they like to call them can have just one or two differences or variations than can either make it less effective or cause interactions to other menications. Simular to them is like Xanax is to Valium.
HMO's have zero business taking Medicaid & Medicare dollars. This is exposing the most vunerable patients to abuses and putting them at a much higher risk. 10 years ago most drug stores in the pharmacy had a pharmicist and an assistant maybe two on a busy day. Most of them now have 6-10 persons. These extra 4-8 persons are to keep up with the Tenn Care Red Tape. That in turn drives up overhead. The mail orders will be the same thing you just won't see them. The biggest problem in Tenn Care is Tenn Care hiarchy and it's HMO's. HMO's are congressionally protected thieves offering services they have no intention of delivering. The untouchables!
Tennessee does not need to be in the Universal Health Care bussiness. Medicaid was not a charity it was a pay in insurance for the workers disability or death. Then they kept expanding it to the mess we now have.
Even better why are we paying for colleges to teach How to decorate Easter eggs, How to wrap Christmas presents or any of the other idiotic Continuing Ed courses that they offer. Sure you pay a small fee for these continuing ed courses, but the fees can't off set the actually cost of the teacher, utilities, insurance, and building use.
Add up all these needless expenditures....Over $200M. By the time you add in the $465M+ waste and fraud in TennCare..at least half that amount for waste and fraud from DayCare. You can see why we have a budget crisis. NO State can keep up that level of fraud, waste and abuse with out a steady INCREASE in taxation levels.
Even a simple high school educated person like me can descern that.
IT'S THE SPENDING, NOT LACK OF TAXES THAT IS THE ROOT CAUSE OF THE BUDGET CRISIS
TennCare is the vehicle to force through the income tax.
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