The program: The District of Columbia launched the D.C. Healthcare Alliance in 2001. The program, which faced a $40 million deficit last year, provides free care to D.C. residents who earn too little to afford private insurance but too much to qualify for Medicaid benefits, and has a budget this year of $129 million. Participation in the Alliance has nearly doubled since June 2006 when the D.C. Income Maintenance Administration, which also enlists people in the food-stamp and Medicaid programs, was tasked with enrollment. IMA’s policies might have opened the door to costly fraud, critics of the program have said.
The problem: A new audit details the complete failure of the D.C. government to prevent outsiders from ripping off a health care program financed by city taxpayers that is designed to provide a safety net for the city’s poorest.
The alliance costs the District $212.21 per member per month, meaning local and federal taxpayers are out $1 million a year for every 400 people who scam it. In 2008, $5.6 million from the D.C. Disproportionate Share Hospital (DSH) payments goes to the Alliance managed care contracts; of the $5.6 million, $3.9 million comes from federal tax dollars.
The alliance costs the District $212.21 per member per month, meaning local and federal taxpayers are out $1 million a year for every 400 people who scam it.
In 2008, $5.6 million from the D.C. Disproportionate Share Hospital (DSH) payments goes to the Alliance managed care contracts; of the $5.6 million, $3.9 million comes from federal tax dollars.
Specific audit findings (as reported by the Washington Examiner):
• Eleven District addresses, not including homeless shelters, accounted for 271 Alliance members, and another 216 addresses accounted for 1,866 members. • The investigation also found that 615 residents who should have been moved into Medicaid the moment they turned 65 were left in the alliance unnecessarily long. • The audit further reported alliance members whose income exceeded the eligibility threshold, who provided expired documents as proof of residency, and who were already receiving benefits in Maryland. • Auditor was unable to confirm the residency of 309 members out of a 360-member sample, and 47 were deemed “questionable.” • IMA does not verify driver’s licenses, claims of income, confirming letters, addresses, alien registration numbers or value of assets. • The auditor also discovered multiple case records established for the same client and payments being made for individuals no longer enrolled in the program. • A review of 344 case files found the majority of recipients used unsubstantiated letters from relatives or friends as proof of their residency in the District. • The auditor also found that 16,720 of 63,167 Alliance data records contained no Social Security number, which may be explained by a large number of illegal immigrants in the program.
Read more here:
"Fraud rampant in health network," by Michael Neibauer, The Examiner, Feb. 21, 2008
"City is likely providing free health care to many nonresidents at a hefty cost," by Michael Neibauer, The Examiner, Feb. 7, 2008
