Report: Inadequate Oversight of Eligibility Alerts by Ohio Department of Medicaid May Cost Millions in Improper Benefits Payments

By Ohio Auditor of State / December 13, 2022

Columbus – The Ohio Department of Medicaid (ODM) did not ensure County Department of Job and Family Services caseworkers processed system alerts to determine if benefits recipients were potentially receiving duplicative assistance from multiple states, according to a new report from Auditor of State Keith Faber.

In total, 59% of the Public Assistance Reporting Information System Alerts reviewed by state auditors were not addressed as required, and the inaction could be costing the state between $5.3 million and $24.5 million annually if ineligible residents are receiving duplicative program support.

A November 2020 report by the U.S. Department of Health and Human Services’ Office of Inspector General identified comparable issues, but no significant progress has been made to address these deficiencies in identifying ineligible recipients in a timely manner.

Tuesday’s report follows a separate audit released in January 2022 that found the Ohio Department of Medicaid (ODM) failed to recoup more than $118.5 million in erroneous duplicate payments or improperly paid for the managed care of prison inmates and deceased residents over a three-year period.

 “There continue to be ongoing oversight issues in Ohio’s Medicaid programs that should have been addressed,” Auditor Faber said. “It’s past time to deal with these problems.”

ODM administers Ohio’s Medicaid Program, which provides health care and other services to about 2.9 million lower income residents, older adults, individuals with disabilities, pregnant women, infants and children, and others. The agency’s spending, at more than $28 billion, accounts for more than one-third of the state’s overall operating budget.

The Auditor of State’s Office regularly reviews spending by ODM and other agencies to ensure their financials are in order and public funds are being properly managed. Ohio also is required to participate in the Public Assistance Reporting Information System (PARIS), which matches data of Medicaid, Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) programs to determine if recipients are receiving benefits in two or more states. 

Residents are not eligible for assistance through ODM if they are enrolled and receiving those same benefits from other states.

PARIS Alerts are generated when residents are enrolled in benefits programs in multiple states. County Job and Family Services Offices are required by ODM to review the alerts and dis-enroll those receiving assistance elsewhere. ODM is responsible for monitoring counties’ timely processing of alerts.

The report issued by the Auditor of State’s Office Tuesday, however, showed that county caseworkers either did not process alerts or address them in a timely manner. (ODM started to compile statistics to monitor the performance of counties’ responses to alerts in July 2022, after the state audit was commenced.)

In June, September and December of 2021, 42,807 Ohio recipients had matching assistance program enrollments in one or more other states. State auditors reviewed a sample of 330 alerts and the Ohio Department of Medicaid’s subsequent responses to each. For 48% of the alerts tested, state auditors found that no steps were taken to determine benefits recipients’ residency, and an additional 11% were not reviewed within required timeframes. 

As a result, benefits for identified recipients were not timely terminated, and improper capitation payments were made. According to Tuesday’s report, “Based on our results, we estimate the combined financial impact of not working PARIS Alerts and not timely working PARIS Alerts could have a potential impact on the Medicaid Program of between $5.3 million and $24.5 million for a 12-month period.”

“We have an alert system for a reason – to ensure public benefits are being issued properly, to the people who need them,” Auditor Faber said. “They’re supposed to get your attention, not be ignored, especially when millions of public dollars are potentially being misspent.”

The Auditor of State’s Office is recommending that ODM evaluate its process for responding to PARIS Alerts, monitor county offices’ responses and provide updated guidance for addressing alerts, and identify and recoup any improper capitation payments that were made for recipients receiving benefits in multiple states.

A full copy of the PARIS Alerts report, as well as the Auditor’s January report on Medicaid capitation payment issues, are available online at https://ohioauditor.gov/auditsearch/search.aspx.