An audit has found that Colorado has paid more than $7 million to insurance companies to handle care for Medicaid recipients who had died.
Why It Matters
Medicaid has been a hot topic in recent weeks after House Republicans appeared to propose making cuts to federal spending on government health programs in its budget. Medicaid, which is for people or families with limited incomes and resources, including children, pregnant women, older adults, and people with disabilities, is used by some 80 million Americans.
What To Know
A report from the U.S. Department of Health and Human Services’ Office of the Inspector General estimates that Colorado paid insurers at least $7.3 million, consisting of approximately $3.8 million in federal funds, for services for deceased Colorado residents.
The payments made were capitation payments, when providers receive a fixed amount per enrolled individual over a set period, regardless of whether the individual uses the health care services.
The report found that in the majority of cases, data from the Social Security Administration’s Death Master File showed a Medicaid enrollee had died, but Colorado didn’t know because it did not have an automated system to check for deaths. In some instances, the state was aware of a person’s death, but still processed the payments.
The report outlines that Colorado began using an automated payment system in 2019 and attempted to recoup payments it shouldn’t have made, but it did not collect payments sent for people listed as no longer qualified for Medicaid. In some cases, the state unenrolled a recipient for failing to return paperwork, even though the person had died, and it did not recover amounts sent out before they were unenrolled.
The state has agreed to three of the terms put forward as a result of the findings. A spokesperson for the Colorado Department of Health Care Policy and Financing refuted some of the claims made in the report because inspectors used state and federal records rather than reaching out to the enrollees to verify whether they were still alive or not.
Newsweek has contacted Colorado’s Centers for Medicare & Medicaid Services via the contact form on its website, and the Department of Health Care Policy and Financing via email.
What People Are Saying
Colorado Department of Health Care Policy and Financing spokesperson Marc Williams told The Denver Post: “Based on the OIG’s inadequate approach in reaching the financial estimates in this report, HCPF will need to spend time disputing the estimates directly with the Centers for Medicare and Medicaid Services, rather than attempting to identify and recover unallowable capitation payments.”
The report reads: “We disagree with the State agency’s comments that our audit work was ‘inadequate’ and did not provide ‘true verification of [our] findings.'”
What’s Next
The Office of the Inspector General has recommended that Colorado pay an estimated $3.8 million to the federal government, and a further $2.2 million for “other Medicaid expenditures that the State agency had previously overreported”
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