Pennsylvania Spent Millions On Medicaid Payments For Ineligible Residents, Audit Finds

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Public Health
Article Date: 02 Feb 2009 - 1:00 PDT

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Pennsylvania has spent millions of dollars annually on Medicaid payments for residents who no longer qualify for the program, according to a state audit released on Wednesday, the Philadelphia Inquirer reports. According to the audit by Auditor General Jack Wagner, the state Department of Public Welfare failed to properly determine eligibility for more than 1,600 Medicaid applicants between January 2005 and March 2008. Auditors believe that failure of DPW to consistently review changes in a beneficiaries' income, age, disability, family status and other factors caused many of the improper eligibility determinations.

According to the audit, errors occurred in 14% of the of 11,700 randomly sampled Medicaid cases examined. Wagner said, "A 14% error rate is unacceptable," adding, "Medicaid is a safety net, and a very important safety net for Pennsylvanians. ... We want to make sure all the available resources are there." The errors resulted in $3.3 million in improper payments during the audit period. However, because the audit involved a small sample of the state's Medicaid caseload, it is likely that the total number and amount of improper payments is higher, Wagner said. He said, "If you begin to look at the total body of Medicare payments ... that dollar volume could be substantial," adding, "We're sure there could be savings in the area of tens of millions of dollars a year." He added that better technology and improved case management could fix some of the mistakes.

Stacey Witalec, a DPW spokesperson, said the department has asked Wagner's office to explain the methodology used in the report, but has not received a response. She said, "We think that he is dramatically overestimating the potential problem," adding, "We are constantly in the mode of making sure that our programs are running as efficiently and effectively as they possibly can. And we are doing more with less" (Couloumbis, Philadelphia Inquirer, 1/29).

The report is available online.

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