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Ohio May Have Paid $455 Million in Improper Medicaid Claims

A technical error in the Medicaid enrollment system may have mispaid 4.9 percent of customers across 27 counties. An audit suggests the numbers could extrapolate to a multi-million dollar glitch for the whole state.

(TNS) — Ohio’s Medicaid system may have paid out hundreds of millions of dollars in improper claims last year to ineligible patients, due to glitches with the state’s computerized enrollment system, according to a new state audit.

As part of a review of 27 counties, the Ohio Auditor’s Office found 16 out of 324 Medicaid customers, or 4.9 perent, shouldn’t have been eligible to enroll in the program. That translated to only $39,135 in improper payments. But extrapolating that number to the state’s overall enrollment numbers, it would translate to as much as $455 million, state Auditor Keith Faber said.

State auditors couldn’t determine why people who should have been ineligible were allowed into the system. That’s because an automated enrollment system that dates back 2013 didn’t sufficiently record information that had been edited or written over.

County caseworkers also reported frustrations with the system, using words like “complicated,” “inefficient,” “frustrating,” “expensive,” and “broken” to describe it to state auditors. “As one of Ohio’s largest budget items, with annual spending in excess of $27 billion, any inefficiencies in the Medicaid system can quickly run up a large tab,” Faber said in a statement. “We must reduce the chance for error by streamlining and simplifying processes and ensuring accuracy in enrollment and reporting. The systemic problems we identified arose over several administrations and must be fixed now. I hope the Department and the current administration will use this report to pursue a more effective system that better serves Ohioans in need.”

Nearly 3 million Ohioans, or about a quarter of the state’s population, are covered by Medicaid, the medical coverage program for the poor and disabled run by the state and federal government.

The state audit isn’t the first reported problem with the new enrollment system, called the Ohio Benefits System, estimated to cost the state and federal government more $1.2 billion to develop. The state switched the OBS application process last year so Ohioans seeking state benefits used the platform to apply online, instead of visiting a caseworker for an in-person interview.

But state food banks quickly found that eligible Ohioans were improperly blocked from enrolling after paperwork was sent to incorrect addresses and call centers had lengthy wait times. And a Cleveland think-tank’s survey, released earlier this month, found most low-income Ohioans don’t have desktop or laptop computers, making it difficult for them to enroll because the system lacked flexibility for basic mobile functions.

State officials are aware of problems. In January, Ohio Medicaid Director Maureen Corcoran wrote a memo to Gov. Mike DeWine, saying there were nearly 1,100 defects just on the health care portion of the system.

An agency spokesman didn’t immediately return a message. But in its official response to the state audit, state Medicaid officials said they were aware of the problems and trying to fix them.

“ODM leadership and program staff take very seriously our responsibility as stewards of every dollar taxpayers contribute to this vital program,” Corcoran’s response reads in part. “Financial oversight; protection against fraud, waste and abuse; and program transparency are paramount to the agency’s ability to support Ohioans who rely on Medicaid for their health coverage.”

(c)2020 The Plain Dealer, Cleveland. Distributed by Tribune Content Agency, LLC.

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