Audit shows state Medicaid agency overpaid clinic by $4.7 million

MM Curator summary


TN Medicaid paid almost $5M for fake visits at a primary care clinic.


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A new audit from the State Comptroller’s Office says the state Medicaid agency overpaid a clinic by $4.7 million.

The audit says the Grove Primary Clinic in West Tennessee inaccurately reported patient reimbursements to the state through either mistakes or fraud.

Documents say the clinic inflated their patient count by more than 44,000 visits over a five-year period, from 2014-2019.

TennCare reimbursed the clinic for the overreported visits.

The audit says the clinic is obligated to return overpayments and could be subject to fines.

The clinic couldn’t be reached for comment because it closed just one day after auditors contacted the owners about their examinations.

This audit comes just one week after TennCare was named in a different federal audit.

That audit from the federal Office of the Inspector General found the state may owe hundreds of millions of dollars to the federal government due to mistakes, over-billing, and improper documentation.

The director of TennCare strongly refutes the federal audit, calling it frustrating and unreasonable.

“What the audit is claiming is that we overclaimed those federal dollars and of course we disagree with that,” Director Stephen Smith said. “We provided in our opinion completely acceptable and suitable information.

The federal investigation is still active, and TennCare is working to appeal the claims right now.

TennCare declined to comment on the audit on Grove Primary Clinic, referring Fox 17 News to the investigation documents.


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