Illinois paid an estimated $4.6 million in state and federal money to health insurance organizations to cover people on Medicaid who were dead, according to a federal audit released this week.
The state paid the money to Medicaid managed care organizations — insurers that administer Medicaid benefits for the state — between Oct. 1, 2015 and Sept. 30, 2017, according to a federal audit released Tuesday. Medicaid is a state and federally funded health insurance program for the poor.
Now, the state has been advised to try to get the money back and repay the federal portion of $3.2 million.
Auditors said the error occurred because the state did not enter the Medicaid beneficiaries’ dates of death into its system used to process payments and track eligibility and enrollment information. The state attributed that error to a technical flaw in the system, according to the audit.
* This is not an Illinois-only problem. From the HHS Office of Inspector General…
The Illinois Department of Healthcare and Family Services (State agency) pays managed care organizations (MCOs) to provide covered health care services in return for a monthly fixed payment for each enrolled beneficiary (capitation payment). Previous Office of Inspector General (OIG) reviews found that State Medicaid agencies had improperly paid capitation payments on behalf of deceased beneficiaries. We conducted a similar review of the State agency, which administers the Medicaid program. […]
The State agency made payments of approximately $11 billion to Medicaid MCOs during our audit period.
Hopefully, the state can get the MCOs to pony up.