Colorado’s Medicaid program made greater than 220,000 funds to well being care suppliers on behalf of people that had been useless, in accordance with a federal investigation that claims the state overcharged the federal authorities greater than $6 million.
Colorado made the month-to-month funds on behalf of practically 9,000 individuals who had been deceased however nonetheless enrolled within the Medicaid program, in accordance with a report launched this month by the Workplace of Inspector Basic within the U.S. Division of Well being and Human Companies.
The state paid $7.8 million from 2018-2020 for well being take care of 4,003 folks whose dates of demise weren’t recorded within the state laptop system and $5.1 million for 4,837 folks whose demise dates had been recorded within the state system, the watchdog company discovered. The cash for these funds got here from a mixture of federal and state {dollars}.
In sum, Colorado overcharged the federal authorities at the least $3.8 million for the funds to useless enrollees, and $2.2 million for different incorrect reimbursements the state acquired from the federal authorities, the report alleges.
State Medicaid officers informed The Solar on Wednesday that they might not pay the federal authorities again for alleged funds for deceased members and disputed that each one the Medicaid members tallied within the federal audit are literally useless.
The audit was carried out from August 2021 by means of October, in the course of the Biden administration and earlier than President Trump fired greater than a dozen inspectors common throughout numerous authorities departments.
9,000 deceased enrollees
The audit used federal Social Safety Administration knowledge to indicate that the practically 9,000 folks nonetheless on Colorado’s Medicaid rolls had been deceased. State officers say these federal data are unreliable.
Colorado’s Medicaid program, which is for folks with low incomes and people with disabilities, covers roughly 1.2 million folks. Its price range for the present fiscal 12 months is roughly $16 billion.
This system is funded by a mix of state and federal cash — together with about $9 billion in federal funds and $5 billion from the state’s common fund for the present fiscal 12 months. States contract with so-called managed care organizations, paying them a per-person, or “capitated,” charge for the well being care that they supply to sufferers.
These funds are reported to the federal Facilities for Medicare and Medicaid Companies, and the federal authorities reimburses the state for the federal share of the fee, which ranged from 50% to 88% in Colorado.
Colorado’s Medicaid program, which known as Well being First Colorado, supplies well being care to folks with developmental, mental or bodily disabilities, in addition to youngsters and adults who qualify based mostly on their revenue. Throughout the audit interval, which was Jan. 1, 2018, to Dec. 31, 2020, the state contracted with 22 managed care organizations to supply medical and behavioral well being care.
Whereas the audit was ongoing, state officers mentioned they had been already conscious of among the funds for deceased Medicaid enrollees and had began to wash up their knowledge set and get well funds, the audit says. Primarily based on the state’s actions, federal auditors narrowed the scope of their overview.
Colorado made the “unallowable” funds on behalf of enrollees who had died “as a result of it didn’t have ample controls” and had subpar insurance policies and procedures, federal auditors wrote. “Amongst different elements, for a portion of our audit interval the state company didn’t have an automatic system to confirm dates of demise,” they mentioned.
Apart from funds for the useless, Colorado overreported $2.2 million in different Medicaid expenditures to the federal authorities. The errors occurred as a result of the state failed to verify its fiscal knowledge vendor precisely reported info, and the state used some duplicate knowledge, the audit report mentioned. State officers discovered the opposite errors, which had been exterior the scope of the audit, and reported them to federal auditors.
$6 million invoice
The inspector common made six suggestions for enchancment, together with that Colorado reimburse the federal authorities $6 million. That features $3.5 million for funds made on behalf of useless enrollees whose demise dates weren’t within the state system and $293,890 for funds made on behalf of useless enrollees whose demise dates had been within the state system.
The full additionally contains $2.2 million for different errors, which Colorado paid again in September, the report mentioned. Colorado officers, nonetheless, termed it a “technical challenge” and mentioned that they had already taken care of compensation in 2022 and had adjusted experiences to the federal Medicaid program.
The OIG additionally really helpful that Colorado recoup overpayments to its managed care organizations and that it strengthen inside controls to confirm date-of-death info.
State officers informed The Solar that as a substitute of paying again the federal authorities, the state will spend time disputing the estimates immediately with the federal Facilities for Medicare and Medicaid Companies. A spokeswoman for the Medicaid program, inside the Colorado Division of Well being Care Coverage and Financing, mentioned the Workplace of the Inspector Basic used “knowledge evaluation of questionable sources slightly than proving true verification of their findings,” and famous that federal Medicaid officers say that states can’t depend on demise knowledge from the Social Safety Administration due to “identified errors.”
States are supposed to verify that enrollees are useless. “The OIG didn’t independently carry out such outreach to presumed deceased members, so the division determines their work to be insufficient,” Colorado Medicaid spokesperson Trish Grodzicki informed The Solar by way of e-mail.
“The division has many management processes to confirm that people have died and is consistently working to boost these controls,” she mentioned.
If there’s a pay again, Grodzicki mentioned, it’ll take two to a few years to barter with the federal authorities.
In its official response to the OIG, Colorado officers mentioned they can not get well funds from managed care organizations that are actually out of enterprise and that a few of its contracts with these organizations prohibit restoration of funds, the audit mentioned. The state additionally countered that repaying the federal authorities based mostly on the audit’s estimates “could outcome” within the state paying again an excessive amount of.
As for strengthening its procedures, state officers responded that it had “already made a number of adjustments.”
The audit is one in every of a sequence involving a number of states. Earlier audits discovered the identical drawback in 16 different states since 2016, the report mentioned.
