Thousands Of Ineligible People Might Be Enrolled In Washington, D.C., No-Cost Health Care Program, According To Draft Audit Report

Main Category: Public Health
Also Included In: Health Insurance / Medical Insurance
Article Date: 26 Feb 2008 - 9:00 PDT

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Thousands of ineligible people might have received no-cost health benefits through the Washington, D.C., Healthcare Alliance, according to a late draft of an audit, the Washington Examiner reports. The $129 million program provides no-cost health care for district residents who do not qualify for other public health programs. Enrollment in the program increased from 34,907 in June 2006 to 46,490 in November 2007. However, the audit found, "There is a risk that applicants may misrepresent facts to obtain eligibility and the misrepresentation may go undetected."

According to the audit:

• The district's Income Maintenance Administration, which administers the program, does not verify driver's licenses, income, addresses, alien registration numbers or assets of applicants;
  
  
• 11 district addresses, not including homeless shelters, accounted for 271 beneficiaries, and another 216 addresses accounted for 1,866 beneficiaries, which auditors said could be evidence that the locations are being fraudulently used to gain enrollment in the program; and
  
  
• As of November 2007, 166 beneficiaries older than age 65 and 33 older than age 70 were still enrolled in the alliance rather than Medicare.
  

The audit also found some beneficiaries had incomes that exceeded eligibility thresholds, provided expired documents as proof of residency or already were receiving benefits in Maryland. In addition, the auditor was unable to confirm the residency of 309 beneficiaries out of a 360-beneficiary sample, and 47 beneficiaries had "questionable" residency. Forty-nine beneficiaries of the sample were homeless individuals "with no evidence of further investigation," the audit found, adding that IMA requires "minimal or no documentation" from applicants who claim to be homeless.

D.C. Council member Tommy Wells said IMA is "not doing the kind of background investigations necessary to weed out fraud," adding that the district has not met the demand for no-cost health care "with adequate controls." Clarence Carter, director of the district Department of Human Services, on Wednesday told the council's Committee on Human Services that the final audit will serve as a "road map" to fix the enrollment process. He added that DHS is "prepared to do whatever we have to do to effectively and efficiently determine eligibility" (Neibauer, Washington Examiner, 2/21).

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