SUBSCRIBE to Capitol Fax      Advertise Here      Mobile Version     Exclusive Subscriber Content     Updated Posts    Contact
CapitolFax.com
To subscribe to Capitol Fax, click here.
Aiming at the wrong target

Friday, May 30, 2014

* This headline is completely, utterly bogus

Audit: $12.3M in Illinois Medicaid benefits paid to dead people

First of all, Medicaid doesn’t pay patients. Medicaid pays providers. And that’s just what happened here, which you’ll finally see after you scroll down several paragraphs

The vast majority of the overpayments — $11.4 million — went to managed care organizations, that is, the private insurance companies with contracts to pay for health care for the poor and disabled. The state pays monthly [capitation] fees to those companies on a per-patient basis, rather than paying doctors and hospitals a fee for each separate service.

* To be sure, however, this was most definitely a supremely massive oversight failure by DHFS. From the audit

We determined that many of the individuals were signed up for managed care months after their date of death. For individuals with Title XIX eligibility in fiscal year 2013, of the 993 individuals whose date of death was more than 60 days prior to the payment date, we identified 561 who were enrolled in managed care and had capitation services paid on their behalf more than 90 days after their date of death. The average number of days they were signed up after their date of death was 663.

Due to the fact that these individuals were deceased, the State in most cases was not paying for any fee-for-service expenses for these individuals after their date of death. However, once the Department enrolled these 561 deceased individuals into managed care, the State began paying their monthly premiums, which totaled $6.96 million through October 1, 2013. The highest monthly rate paid was $5,384. [Emphasis added.]

Oy.

An accompanying chart shows managed care payments on behalf of people who’d been dead more than 60 days were about $50,000 a month back in July of 2011, but shot way up to almost $900,000 a month by October, 2013.

Plain and simple, DHFS dropped the ball.

Bigtime.

* From the agency’s audit response

Because capitation payments for individuals enrolled in managed care are made prospectively and the Department may not be immediately notified of an individual’s death, Department policy provides for recoupment of improper payments for deceased individuals from managed care companies.

As deaths are recorded in Department systems, the information is automatically processed to deduct up to 18 months of overpayments for deceased individuals from future payments. […]

As of February 10, 2014, 98% of the 993 people associated with the capitation overpayments identified in this audit have been properly coded as deceased in Department systems. The Department has recouped or is in the process of recouping the $11.4 million in capitation overpayments under managed care that were identified in this audit. The Department expects all overpayments to be recouped by year’s end.

OK, fine, but fix the darned problem.

- Posted by Rich Miller        


11 Comments
  1. - anon - Friday, May 30, 14 @ 10:51 am:

    There are equal parts understaffing, incompetence, and arrogance at that agency. Seriously, the staff has a significant work burden that is made more difficult by the whims of the general assembly (whether its negating contracts entered into by the department, or passing legislation that requires new coverages without matching appropriations). HFS needs more people to do its job effectively. With that said, some of the senior staff at HFS are so arrogant that even if this problem was brought to their attention, they would have ignored it because they have things “under control.” The things that are slipping through the cracks over there is obscene.


  2. - VanillaMan - Friday, May 30, 14 @ 10:52 am:

    Yes.
    The buckets we use are filled with leaks. So what we do is use paper Dixie cups to catch the water leaking from the buckets and when these fill, we empty them back into the buckets.

    Last year we spent $15,000,000 on Dixie cups.


  3. - Anon. - Friday, May 30, 14 @ 11:01 am:

    Cue the jokes about how many of these decedents continued to vote.


  4. - Anonymous - Friday, May 30, 14 @ 11:22 am:

    ==Cue the jokes about how many of these decedents continued to vote.==

    Well they were going to vote, but not now for the guy who just slashed their health care!


  5. - Eastsider - Friday, May 30, 14 @ 11:27 am:

    Does anyone in this discussion understand how capitation works? From the comments I’m guessing no.


  6. - Anyone Remember - Friday, May 30, 14 @ 11:36 am:

    Does anyone have headcount figures for the relevant HFS units from before the ERI to the current date?


  7. - JustMe_JMO - Friday, May 30, 14 @ 12:50 pm:

    Just how hard is it to allow access to the State’s Death database?

    “A project manager has been hired to enforce contract milestones” was there a prior manager? If so were the fined / fired?


  8. - wordslinger - Friday, May 30, 14 @ 12:55 pm:

    The headline is embarrassing, but it’s not surprising.

    I’ve come across a fair amount of people who believe Medicaid beneficiaries get checks in the mail.


  9. - Formerly Known As... - Friday, May 30, 14 @ 1:58 pm:

    A 663 day gap is unacceptable at any level.


  10. - Anon. - Friday, May 30, 14 @ 2:25 pm:

    ==Does anyone in this discussion understand how capitation works?==

    In the US constitution, it means a “head tax,” that is, a tax that is the same amount on every taxable human being. Does that help?

    If it means a system where the health care provider gets paid a certain amount per patient ccvered by a plan, regardless of services provided, how does that help to justify showing people as continuing to be covered and paying for them for an average of nearly two years after they died?


  11. - Federalist - Friday, May 30, 14 @ 5:26 pm:

    Why am I not surprised that much of the media is even more unaware than many of us and keep posting such dumb headlines.

    Will they ever learn? Probably not!


Sorry, comments for this post are now closed.


* Exelon Tells Wall Street Its Illinois Plants Make Money So Why Is It Still Asking Springfield For A Bailout??
* Stop the silly games
* Question of the day
* Poll: Chicagoans are fed up
* Kudos and barbs
* Sen. Kirk says Trump a "net benefit" to the party
* SIU warns of big trouble directly ahead
* Kristen McQueary discovers her inner Poindexter
* More like this, please
* More green shoots?
* Emanuel refuses CTU's offer to help
* *** UPDATED x1 *** No Cleveland for Rauner
* SUBSCRIBERS ONLY - Supplement to today’s edition
* SUBSCRIBERS ONLY - Today's edition of Capitol Fax (use all CAPS in password)
* Good morning!
* Yesterday's blog posts

Support CapitolFax.com
Visit our advertisers...

...............

...............

...............

...............

...............

...............

...............


Search This Blog...

Search the 98th General Assembly By Bill Number
(example: HB0001)

Search the 98th General Assembly By Keyword

  
* Talk conversationally dirty to me, Google
* MacRumors Giveaway: Win a Limited Edition 'Lost Time' UE Boom 2 Speaker From Ultimate Ears
* Does Phone Camera Aperture Size Matter? Huawei P9 vs Galaxy S7!
* Android One looks for more freedom, more growth
* [TA Deals] Save 47% on a Blumoo Bluetooth Universal Remote
* Samsung Gear Fit 2 renders appear in several colors
* Android One program gets absorbed by Google’s new hardware division

* Latos aiming to rebound in series opener vs. Twins
* Avisail homers, but White Sox rally thwarted
* White Sox left frustrated on close play at plate
* Avisail homers, but White Sox rally thwarted
* Brett Lawrie is the brand-new 'Canadian vampire'
* White Sox honor Ortiz; Commish on hand
* Avisail homers, but White Sox rally thwarted

...............


Main Menu
Home
Illinois
YouTube
Pundit rankings
Obama
Subscriber Content
Durbin
Burris
Blagojevich Trial
Advertising
Updated Posts
Polls

Archives
May 2016
April 2016
March 2016
February 2016
January 2016
December 2015
November 2015
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
April 2015
March 2015
February 2015
January 2015
December 2014
November 2014
October 2014
September 2014
August 2014
July 2014
June 2014
May 2014
April 2014
March 2014
February 2014
January 2014
December 2013
November 2013
October 2013
September 2013
August 2013
July 2013
June 2013
May 2013
April 2013
March 2013
February 2013
January 2013
December 2012
November 2012
October 2012
September 2012
August 2012
July 2012
June 2012
May 2012
April 2012
March 2012
February 2012
January 2012
December 2011
November 2011
October 2011
September 2011
August 2011
July 2011
June 2011
May 2011
April 2011
March 2011
February 2011
January 2011
December 2010
November 2010
October 2010
September 2010
August 2010
July 2010
June 2010
May 2010
April 2010
March 2010
February 2010
January 2010
December 2009
November 2009
October 2009
September 2009
August 2009
July 2009
June 2009
May 2009
April 2009
March 2009
February 2009
January 2009
December 2008
November 2008
October 2008
September 2008
August 2008
July 2008
June 2008
May 2008
April 2008
March 2008
February 2008
January 2008
December 2007
November 2007
October 2007
September 2007
August 2007
July 2007
June 2007
May 2007
April 2007
March 2007
February 2007
January 2007
December 2006
November 2006
October 2006
September 2006
August 2006
July 2006
June 2006
May 2006
April 2006
March 2006
February 2006
January 2006
December 2005
April 2005
March 2005
February 2005
January 2005
December 2004
November 2004
October 2004

Blog*Spot Archives
November 2005
October 2005
September 2005
August 2005
July 2005
June 2005
May 2005

Syndication

RSS Feed 2.0
Comments RSS 2.0
WordPress

Loading


* Union files unfair labor charge against state o.....
* Kristen McQueary discovers her inner Poindexter.....
* Gov. Rauner Won't Endorse Trump Or Attend The R.....
* SEIU Illinois files unfair labor claim on home-.....
* QC nuclear plant could close in 2018, company says..
* SEIU Illinois files unfair labor claim on home-.....


* Bond at $5M for ex-prosecutor facing retrial in wife's death
* Commission approves plan to evenly spread O'Hare noise
* Illinois collects another $1.6M from late-vehicle fines
* SIUE approves contracts for temporary service employees
* Black University of Illinois workers allege discrimination
* SEIU Illinois files unfair labor claim on home-care work
* Report finds false, faulty testimony by Chicago officers
* Woodstock's deputy police chief appointed to top cop job
* Illinois voters to see road fund amendment on Nov 8 ballot
* EXCHANGE: Nature in reach with Lake Sara kayak launch site

* SEIU Illinois files unfair labor claim on home-care work
* Late-vehicle registration fines up to $6.5M through April
* Black U of I workers allege discrimination
* Illinois Senate OKs lawyers for juvenile murder suspects
* Illinois Senate passes $454 million more for colleges
* Memorial day honors fallen Illinois police officers and their families
* Road fund bill the only constitutional amendment to pass both chambers
* Vote on school funding reform plan delayed
* Illinois GOP lawmakers want campaign spending answers from Auditor General Frank Mautino
* Event showcases Illinois students' history research

* Commission approves plan to evenly spread O'Hare noise
* Can this e-commerce startup challenge Amazon in Chicago?
* World's rich families are putting private equity firms on notice
* More than trauma center needed to bridge Chicago's life expectancy gap
* Spotify-backed startup scores music streaming deal with McDonald's


* Group of masked men commit three robberies in Waukegan
* Chicago man charged with burglarizing Park Ridge Jiffy Lube
* Ready to jump on a Divvy bike now? There’s an app for that
* Man missing from Beverly
* Union files unfair labor charge against state over overtime ban
* Police-involved shooting in ‘fugitive encounter’ in West Pullman
* Tales from the Front: How ex is your ex?
* The Butler smear campaign has ticked off guard Jimmy Butler
* Lincoln-Way Central on lockdown over person carrying object
* O’Hare commission approves night flight plan to spread out noise


* Crystal Lake couple creates family with help from frozen embryo donations
* Canadian convoy begins, hoping to flee wildfire zone
* Police: 1 dead, 3 hurt in shooting outside mall in D.C. suburbs
* Bill inspired by Robbins 'travesty' would create sexual assault investigation oversight
* Robbery suspect shot by Chicago police executing warrant in West Pullman
* Chicago State: School must work harder to find funds, students
* U.S. doubles down on Egypt's dictator
* Mel Reynolds writes jailhouse plea for transfer to halfway house
* 1 dead, 1 hurt when 4 vehicles collide on Kennedy near Harlem
* Troy LaRaviere talks about his CPS ouster, doesn't address misconduct allegations


* SEIU Illinois files unfair labor claim on home-care work
* Late-vehicle registration fines up to $6.5M through April
* Black U of I workers allege discrimination
* Illinois Senate OKs lawyers for juvenile murder suspects
* Their View: Nepal, stuck in neutral as aid languishes
* Their View: A lifeline for Puerto Rico
* Illinois Senate passes $454 million more for colleges
* Memorial day honors fallen Illinois police officers and their families
* Road fund bill the only constitutional amendment to pass both chambers
* Vote on school funding reform plan delayed


* UPDATE: Prognosis promising for injured eagle
* 05-06-16 Penny for Your Thoughts
* Why Ebertfest, marathon will share same weekend in '17
* Fractured GOP shows no immediate signs of mending itself
* Colombia arrests alleged money launderer from Panama
* Illinois Senate OKs lawyers for juvenile murder suspects
* Canadian convoy fleeing wildfire zone
* Ex-prosecutor facing retrial back in court
* Jobless rate stays at 5 percent in April
* Democratic ad blitz awaits GOP's Trump


* 5 entertaining options for the weekend
* Libertyville water, sewer rates up
* Stevenson teachers to appear on C-SPAN Saturday
* Author Jane Hamilton coming to Gurnee
* Services set for Buffalo Grove woman killed in Wisconsin shooring

* House lawmakers overcome hurdle on key tra...
* Rodney Davis talks funding with Bloomingto...
* The agency that fought Illiana gets a new ...
* Rep. Dold takes educational cruise down Ch...
* Lawmakers decry high turnover rate of VA h...
* CBD Oil, and politics
* Simon considering state Senate bid
* Killer Congressman Tom MacArthur trying to...
* Shutdown? State may not notice
* Rep. Bob Dold

* Senator Durbin Corrects the Record on Gitm......

* Donald Trump looms large in key Senate rac......

* Sheridan Park Preservationist Dick Uyvari Remembered
* Pop-Up Plant and Seed Sale This Weekend
* 4027 Broadway Ready For Occupancy
* Human, Social Services Agencies Suing Illinois Over Breach Of Contract
* Two Rooms Playing At Chase Park This Weekend
* Report: On-Campus Child Care Services On The Decline At Universities, Colleges
* Sandack: We don't oppose fantasy sports, we just want assurance they're not rigged
* Kirk expects to win because he's voted for gay rights and abortion, against guns
* Attempted Kidnapping In Lincoln Square Yesterday - Stay Aware & Alert
* West Virginia coal worker confronts Clinton over anti-coal comments


* Emergency Management Officials, National Weather Service Encourage Winter Preparedness - November is Winter Weather Preparedness Month in Illinois
* Keep Your Family Safe This Winter - November through February are leading months for carbon monoxide related incidents
* Governor Takes Bill Action
* Illinois Department of Labor Director Hugo Chaviano Awards Governor’s Award for Contributions in Health and Safety to the Illinois Refining Division of Marathon Petroleum Company LP
* State Regulator Elected Treasurer of Interstate Medical Licensure Compact




Hosted by MCS -- CapitolFax.com Privacy Policy -- SUBSCRIBE to Capitol Fax -- Advertise Here -- Mobile Version -- Contact Rich Miller