Taylor Says Cincinnati Nursing Facility Incorrectly Billed the State More Than $287,000

Thursday, October 11, 2007

Cincinnati -

State Auditor Mary Taylor released the Medicaid provider audit of a Cincinnati based nursing facility today. The audit of Burlington House indicates the provider incorrectly billed the Ohio Department of Job and Family Services (ODJFS) more than $287,000 in room and board and therapy services.

“Medicaid providers must review billing statements to ensure that public funds are spent legally and appropriately,” Taylor said. “The failure to do so increases the potential of misspending or outright fraud and could jeopardize the funding of a program serving some of the state’s most vulnerable citizens.”

The total amount Burlington House may owe the state is $287,545.61. The audit reveals that 160 claims, 134 claims for room and board and 26 claims for therapy services, filed by Burlington House 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
  • Claims billed to Medicaid when patients were not even living in the facility at that time
  • Therapy claims where the units performed were over billed

The audit reviewed Medicaid reimbursements made to Burlington House from July 1, 2004 through December 31, 2005 for room and board as well as therapy services. During this period, Burlington House was reimbursed a total of $5,187,109.09 for 1,234 Medicaid claims.

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 department’s responsibility 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.

This is the second Medicaid provider audit released under the new authority of the State Auditor. The first audit reviewed Medicaid payments made to Toledo based Brookeside Ambulette. That audit uncovered nearly $600,000 in possible Medicaid overpayments, duplicate claims and claims submitted for services provided to deceased patients.

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.