Wednesday, April 26, 2000
Auditor: Medicaid billed for services after death
Seven local firms asked for repayment
By Tim Bonfield and Lucy May
The Cincinnati Enquirer
Ohio's Medicaid system has paid nearly half a million dollars over five years to seven local companies for services to people who were dead, said State Auditor Jim Petro.
The auditor wants three area nursing homes, two pharmacies and two medical equipment suppliers to repay a combined $440,302 in alleged Medicaid overpayments. The state claims the companies billed Medicaid for services performed after the patients had died.
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COMPANIES INVOLVED
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A report from the Ohio Auditor's office names seven local companies as receiving more than $440,000 (combined) in Medicaid payments for services to patients who had died:
• Westside Health Care, intermediate care facility, 1857 Grand Ave., Price Hill, $101,664.21
• HCMC Inc., medical equipment, 8900 Glendale-Milford Road, Loveland, $94,789.08
• RXO2 Inc., medical equipment, 1587 Kinney Ave., Mount Healthy, $66,513.60
• Skilled Care Pharmacy, 6961 Cintas Blvd., Mason, $55,887.72
• Oakside Nursing Home, intermediate care facility, 3545 Eden Ave., Cincinnati, $43,330.59
• Home Care Pharmacy, 5549 Spellmire Drive, West Chester, $39,315.92
• Lindy Manor Nursing Home, intermediate care facility, 1153 Lindy St., (now closed) $38,801.36
Source: Ohio auditor's office
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That money is part of $14 million in unrecovered funds statewide for disputed bills between 1994 and 1999.
The Ohio Department of Human Services has hired the accounting firm Deloitte & Touche to recover the funds statewide, said depart ment spokesman Jon Allen. If the funds can't be recovered, the matter could be referred to the Ohio Attorney General's office for prosecution, he said.
Mr. Petro suggested ways to improve the Medicaid billing system, including giving the human services department authority to fine pro viders who don't report a death in a timely fashion.
The department has advocated an estimated $1 million billing system that would notify state officials directly when a Medicaid recipient dies. However, the General Assembly has not provided any funding.
The Enquirer attempted to contact all seven companies Tuesday, reaching all but three. Some said they were working to correct mistakes. Others said they were surprised to find their companies listed in the auditor's report.
“This is the first I've heard of this,” said Larry Galluzzo, owner of Skilled Care Pharmacy, a Mason company that supplies medications to area nursing homes. “We get our orders daily from nursing homes. I don't know how we could be filling out orders for dead people.”
The auditor reported that Skilled Care Pharmacy owes $55,887 in overpayments. But Mr. Galluzzo said he has received no notice from the state.
“I've been in business 18 years and from the letter you're getting it sounds like we're doing something wrong, and that's not right,” Mr. Galluzzo said.
At this point, state officials are not accusing the companies of fraud. The state is just trying to get its money back, Mr. Allen said.
“Unfortunately, the way the system is set up, overpayment and reimbursement is part of the system,” Mr. Allen said.
After a Medicaid recipient dies, a nursing home has five days to notify the county department of human services, he said. The county then has 10 days to verify the death and alert the state.
That means the state can end up sending a month's payment to a nursing home before officials find out the Medicaid recipient has died, and the nursing home must send back any overpayments, he said.
Pharmacies can get caught in that time delay, too.
Howard Coomes, owner of the medical equipment company HCMC Inc., said he has met with the auditor's office in the past month but until Tuesday had never heard how much money was involved. The state alleges HCMC has received $94,789 in overpayments.
“The problem did occur, but it has been resolved since 1998. It appeared to be a computer glitch on our end and theirs,” Mr. Coomes said.
Apparently, some Medicaid patients who were renting medical equipment had died and the equipment had been returned, but the death data were not entered promptly enough on the computer.
Since 1998, new software has eliminated the problem, Mr. Coomes said. Without an official report from the state, he said he could not say whether the $94,000 figure was accurate.
The auditor claims Home Care Pharmacy, 5549 Spellmire Drive, owes $39,315. The company has been owned since 1988 by Omnicare Inc.
Omnicare spokeswoman Cheryl Hodges said the company would gladly return any alleged overpayments but has received no information from the state. At most, the money involved points to a small-scale clerical issue, she said.
In the past six years, Home Care Pharmacy has filled more than 4 million prescriptions for Ohio Medicaid patients for a total billing exceeding $89 million. The $39,000 in disputed payments adds up to about 4 one-hundreths of 1 percent of Home Care's total billings, she said.
Representatives of Westside Health Care and Oakside Nursing Home did not return phone calls. The owner of RXO2 Inc. was contacted Tuesday but declined comment. The former owners of the now-closed Lindy Manor Nursing Home could not be reached.
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