Audit Suggests People Outside Washington, D.C., Enrolling In Health Care Program For Low-Income District Residents

Main Category: Health Insurance / Medical Insurance
Article Date: 12 Feb 2008 - 7:00 PDT

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An ongoing audit of the Washington, D.C., Healthcare Alliance has raised suspicions that non-district residents are enrolled in the program, the Washington Examiner reports. The Alliance offers no-cost care for district residents who cannot afford private insurance but are not eligible for Medicaid. The program costs the district $129 million annually.

In a draft audit of the alliance, consulting firm Bert Smith noted a "significantly high occurrence" of people using the same address, multiple case records established for the same client and payments being made for people no longer enrolled in the program. A review of 344 case records showed that most enrollees used unsubstantiated letters from friends or family members to prove their residency in the district, the Examiner reports. Of 63,167 data records reviewed, 16,720 include no Social Security number, which might indicate that there is a large number of undocumented immigrants enrolled in the program, according to the audit.

Clarence Carter, director of the district's Department of Human Services, last week said an "antiquated automated eligibility program" and loose enrollment standards are to blame for the potential fraud. Sharon Baskerville, executive director of the D.C. Primary Care Association, said, "There's nothing that Bert Smith can say that we're not already aware of and made recommendations to fix," adding, "We continue to fix a bureaucracy that took on an innovative program that it didn't have the infrastructure to manage" (Neibauer, Washington Examiner, 2/7).

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