Title : Insurance Network Health - A millionaire got N.J. health insurance for the poor. That's what an audit just found.
link : Insurance Network Health - A millionaire got N.J. health insurance for the poor. That's what an audit just found.
Insurance Network Health - A millionaire got N.J. health insurance for the poor. That's what an audit just found.
Insurance Network Health - A millionaire got N.J. health insurance for the poor. That's what an audit just found.
Only low-income and working poor people are eligible for NJ
FamilyCare, the state's Medicaid program, but about 1,400 people who
earned too much to qualify billed the plan for $4.6 million in health
care, according to a new state audit report.
That included people who didn't report their spouses' income. In many
cases, that spouse made six-figure salaries, and the report noted that
this ranged as high as someone earning $4.2 million.
Considering there are 1.4 million low-income beneficiaries, the
would-be scammers and questionable members represent the minority. Yet
the Office of the State Auditor detected several examples of weak checks
and balances that cost the state money.
According to the report:
* 1,337 enrollees did not report income earned by a spouse ranging
from $100,000 to $4.2 million, which would have disqualified them for
the program. About 1,000 received $3.9 million in medical care.
* 135 enrollees in 2016 earned more than $100,000 and billed the program $596,000 for medical care.
* 89 out of 96 state employees evaluated by the auditor earned too
much to be eligible for FamilyCare but were enrolled anyway. Their
claims cost the program $444,406 in 2016.
Families may earn no more than 138 percent above the federal poverty
line to qualify, which equates to $2,829 month or about $34,000 a year
for a family of four, according to the program's rules.
Some of these problems would be solved by double-checking application information with tax returns, the report said.
Tom Hester, a spokesman for the Department of Human Services, which
oversees Medicaid/FamilyCare, said the department is reviewing the
audit's findings and recommendations.
"The concerns in the audit were noted from July 2014 to July 2017,
during the previous administration, and DHS is already in the process of
implementing changes to strengthen this valuable program," Hester said.
As it does with other people who fail to report all of their income,
the department will find the rule-breakers, bar them for the program
and refer cases to the Medicaid Fraud Division in the Office of the
State Comptroller. Hester said.
In a written response to state auditor, Human Services Commissioner Carole Johnson challenged some of the findings.
The audit noted, for instance, that $177.5 million payments were made
on behalf of 18,000 people whose Social Security numbers in the
enrollment system were invalid or duplicated. The auditor identified
those as "potential improper payments."
But Johnson disagreed, saying Social Security numbers are later
verified, or if the number is not available, people are tracked by their
date of birth.
The audit urged the department to use state and federal tax return
information to verify income, but that's not always readily available,
Hester added.
"Access to federal tax information and its current agreement with the
New Jersey Division of Taxation is limited, however, we intend to
review the agreement with the Division of Taxation to determine whether
additional information can be accessed to improve eligibility
determinations as well as to identify additional ways to enhance access
to tax information," Hester said.
Tax information may not always be the most current record of what someone is earning now, he added.
A similar audit 10 years ago found similar problems allowing people who earn too much to enroll in the program.
Sen. Joseph Vitale, D-Middlesex, chairman of the Senate Health, Human
Services and Senior Citizens Committee, called the latest audit's
revelations "outrageous."
"The qualifications are straightforward. There is nothing ambiguous
about what the income limitations are," Vitale said. "Either you are
really bad at math or you are trying to beat the system. The system has
to be improved, and those who are not eligible they should make
restitution."
source : https://www.nj.com/politics/index.ssf/2018/09/scammers_used_insurance_for_the_poor_cashed_in_on.html
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