By John Lyon
Arkansas News Bureau
LITTLE ROCK — A recent audit of the state Medicaid program found that 14 percent of claims reviewed for compliance went to people who were ineligible, a legislative panel heard today.
An audit report presented to the Legislative Joint Auditing Committee showed auditors reviewed 155 cases involving $5.7 million in claims. Auditors only considered cases in which compliance was not automatic, and they placed a greater focus on cases that involved complex decisions about eligibility.
Of those 155 cases, no problems were found with 94 cases involving claims totaling $2.5 million, or 43 percent of the $5.7 million total. Inadequate documentation of eligibility was found In 37 cases involving $2.4 million in claims, or 43 percent, though auditors found the recipients were eligible.
In five cases involving $132,457 in claims, or 2 percent, the recipients were aliens who were in the country legally but were not eligible for Medicaid. In the remaining 19 cases involving $677,671 in claims, or 12 percent, the recipients were not eligible.
Auditors said the tremendous growth of the program has increased the workload of caseworkers, likely contributing to the errors. They also cited rapid turnover among caseworkers and caseworkers’ insufficient knowledge of eligibility requirements.
The number of Medicaid recipients in the state has grown 53 percent in the past decade, from 534,911 in 2000 to 817,103 this year, auditors told the panel.
State Department of Human Services Director John Selig testified that when federal agencies have reviewed the program they have found about a 98 percent accuracy rate in eligibility determination.
“But Legislative Audit has found a particular group that really is high-risk for us,” Selig said. “We appreciate them identifying the area where we are vulnerable. … We are aggressively pursuing tighter review and training for these particularly complex cases.”
Committee members accepted the report with few questions.
“You have such a large agency, I don’t know how you even begin to keep up with everything,” the committee’s Senate chairman, Bobby Glover, D-Carlisle, told Selig.
April 9th, 2010 at 7:26 pm
This really isnt fair and not surprising too though. I am on Medicaid (AR) and will be for the rest of my life more than likely. Medicaid wont even pay for a pregnancy test cause they said my family doc didnt get “prior auth” for it. That’s just an excuse!!! I think they put all different reasons to deny claims in something like a bingo “hopper” and spin it around and then draw out a piece of paper and whatever is on the paper is the reason they put for denial. And then now, i find out that many people who was ineligible for Medicaid in the first place got there claims paid!!! Outrageous!!! All i hear is reason’s why the government is and always will be horrible at running things!!! But, I do have to give Obamacare thumbs up on this: bad care is better than no care at all! Im about to have my second back surgery…if it wasnt for me having Medicaid, no one would even give me the time of day. So, even though nothing is getting pd for me, at least i have the opportunity to get stuff done that needs to be done.