Gov. Nathan Deal said Wednesday it could be several years before the state knows whether it has to refund $250 million it paid to nursing homes in recent years.
The federal government wants the state to return the money paid to a Middle Georgia nursing home chain, saying the payments were disallowed by Medicaid regulations.
The Department of Community Health says it has stopped making the higher payments —- as part of the Upper Payment Limit program —- to the 34 nursing facilities under scrutiny by the federal government.
But it argued that the federal Centers for Medicare & Medicaid Services approved of its payment methods for years prior to coming out with a report in December asking for the money back. The state has sent a response to the federal government and hasn’t yet returned any money.
Having to return the money would be a big hit for Georgia’s Medicaid program, which spends about $1 billion a year on nursing home services.
“Any time you’re talking about those kinds of dollars, there has to be concern,” Deal told reporters Wednesday.
“But as you know, these kinds of requests or claims take many years sometimes to sort out, and to determine if money was inappropriately paid, and if so, the exact amount,” he added. “We are early in that process.”
The CEO of the company, Ronnie Rollins of Macon-based Community Health Services of Georgia, told Georgia Health News he was “speechless and stunned” by the request by the federal government.
The nursing home payments in question are part of a complex formula. Essentially, using UPLs, the state can get higher, Medicare-level rates for providing services, like nursing home stays, paid for by Medicaid.
Medicare provides health coverage for the elderly. Medicaid is the state-federal health care plan for the poor and disabled, but it also pays for most nursing home stays in Georgia.
Under UPL, health care providers can put up matching funds and get the higher payments in return.
According to the federal report, the state said the 35 Georgia nursing homes in question were owned by local development authorities, which provided the matching money. In fact, CMS said the homes were privately owned by Rollins’ company, not owned by a public agency, as required, and the matching money came from a privately owned cash management company operating on behalf of the nursing homes.
Rollins and company officials are leading campaign contributors to top politicians, like Deal. It has at least two members on the board of the Georgia Health Care Association, the politically powerful nursing home lobby.
Support real journalism. Support local journalism. Subscribe to The Atlanta Journal-Constitution today. See offers.
Your subscription to the Atlanta Journal-Constitution funds in-depth reporting and investigations that keep you informed. Thank you for supporting real journalism.
Staff writer Greg Bluestein contributed to this report