State releases list of nursing homes involved in repayment dispute

PROVIDENCE 2019--PROVIDENCE -- A public-information request has elicited the names of the 93 nursing homes the state is chasing for the repayment of $84.3 million in "interim payments'' for which most of the homes have now been paid a second time.

Oakland Grove Associates -- the operator of the Oakland Grove Health Care Center in Woonsocket -- tops the list provided Thursday by the Executive Office of Health and Human Services, with the state seeking to recoup $3.1 million.

Oakland Grove is one of five nursing homes that the Athena Health Care System operates in Rhode Island.

The state is seeking to recover a total of $11.1 million from four of those homes. That includes nearly $3 million from the Waterview Villa Rehabilitation and Health Care Center in East Providence; $2.5 million from Heatherwood Rehabilitation & Health Care Center in Newport; and $2.5 million from the Summit Commons Rehabilitation and Health Care Center in Providence.

The nursing homes have been in a tug-of-war with the state over the repayment of Medicaid dollars the state, in effect, loaned them to hold them over while the applications of scores of prospective nursing-home patients were snagged for long periods by the state's balky "UHIP" computer system.

UHIP -- short for the Unified Health Infrastructure Project -- was supposed to streamline eligibility verification for the food stamp program (now known as SNAP), Medicaid, subsidized child care and cash assistance. It experienced major failures after launching in September 2016. The effort to fix it has taken years.

The state's battle to recoup $84.3 million of the $132 million in advance payments given the state's nursing homes since early 2017 marks the latest in a series of direct and indirect problems that have dogged the state -- and its residents -- since the ill-fated launch of the $617-million Deloitte-designed computer system.

The majority of these cases were "double billed,'' meaning an interim payment was made, then the claim was approved and paid out after patients caught for extended periods of time in verification limbo were finally deemed eligible for the government assistance. Another $15.8 million represents money advanced to the nursing homes for patients, since deemed eligible for Medicaid, for which no bills have come in.

The third category -- $18.6 million -- represents interim payments prior to February 2017 for which there are still "missing claims level information."

Top state health and human services officials put lawmakers on notice earlier this week that they intend to escalate their recovery efforts by docking nursing homes amounts they are currently due, starting in May.

And that is just the beginning.

David Levesque, spokesman for the Executive Office of Health and Human Services, said Thursday that there are also "outstanding interim payments for assisted-living, hospice and home care providers as well."

On Thursday, Tim Brown, the director of marketing and communications for Athena Health Care Systems, told The Journal:

"All of our centers take a wide array of patients with varying admissions diagnoses, from skilled nursing (traditional long-term care) to post-hospital care and rehabilitation, to those with medically complex care needs and various forms of memory care and dementia. Our centers have worked out a payment plan that was accepted by the state and are actively making payments."

He declined to elaborate on the terms.

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