State audit: Ohio Medicaid officials overpaid $118 million for ineligible enrollees, including prisoners and dead people
Andrew J. Tobias \ Published: Jan. 14, 2022
COLUMBUS, Ohio -- Ohio Medicaid officials failed to recover more than $118 million they improperly paid to vendors due to ineligible program enrollees, including those who were either in prison or dead, according to a new state audit.
In Ohio, Medicaid, the government health-care program for the poor and disabled, claims are administered through companies referred to as managed-care organizations. Since these companies are paid through a formula based on the number of people who are enrolled in Medicaid, they get paid whether or not someone actually receives medical services.
So Ohio Auditor Keith Faber’s staff cross-referenced the names and personal information of prisoners and dead people against state Medicaid rolls from 2018 to 2020, and then checked whether state officials had filed to recoup any money paid based to managed-care organizations based on their enrollment.
Auditors found $118.5 million in improper payments, which also included those based on duplicate enrollees and enrollees lacking proper personal identifying information, like the system displaying a number for someone’s name, and in the instance of 80,000 enrollees, invalid social security numbers like 000-00-0000.
Auditors recommended the Medicaid department work to recoup the money, and also develop better internal quality-control processes to detect and prevent improper payments.
In their official response, state Medicaid officials said many of the issues had to do with defects in the state’s automated enrollment system, Ohio Benefits. They said they have worked to improve the system since Gov. Mike DeWine took office in January 2019.
“ODM takes seriously its responsibility to make capitation payments based on the most accurate data available and has implemented the processes described in this response to improve and monitor managed care enrollment and capitation payments to MCOs,” the response from Medicaid administrators reads.
Nearly 2.9 million Ohioans -- about a quarter of the state’s population -- are enrolled in Medicaid. The program, jointly funded and administered by the state and federal government, is the state’s single largest expense, representing more than one-third of the state budget.