Home Economy Government R.I. Medicaid paid more than $7M in services for deceased beneficiaries, audit...

R.I. Medicaid paid more than $7M in services for deceased beneficiaries, audit finds

By

Christopher Allen

-

05/07/2024

EOHHS — AN AUDIT RELEASED MAY 1 found the state paid at least $7 million to managed care organizations for dead beneficiaries in fiscal year 2023.

PROVIDENCE – The state’s Medicaid program disbursed more than $7 million to managed care organizations for deceased beneficiaries in fiscal year 2023, an audit by the R.I. Joint Committee on Legislative Services concluded. The state paid $2 million of the total cost, while the remaining $5.1 million was paid by the federal government, according to

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PROVIDENCE – The state’s Medicaid program disbursed more than $7 million to managed care organizations for deceased beneficiaries in fiscal year 2023, an audit by the R.I. Joint Committee on Legislative Services concluded. The state paid $2 million of the total cost, while the remaining $5.1 million was paid by the federal government, according to the report released on May 1. Conducted by the R.I. Auditor General David A. Bergantino, the audit found deficiencies continue within the state's Medicaid program managed by the R.I. Executive Office of Health and Human Services, with state auditors identifying 3,298 deceased members still active on Medicaid as of June 30, 2023. Of that total, 521 members had been deceased for more than two years. A previous state audit conducted with the U.S. Department of Health and Human Services Inspector General showed $38 million in payments between Jan. 2019-2021 were made to beneficiaries residing out of state. A spokesperson for EOHHS did not immediately respond to a request for comment. But in the office's response to the findings included in the report, EOHHS issued a corrective action plan that includes a “permanent system fix" to the RIBridges system that is used to determine eligibility “that will improve communication of the date of death to the Medicaid Management Information System." EOHHS said the fix will be implemented by June 28 and that all ineligible payments will be reimbursed by Sept. 30. Medicaid currently represents the largest expenditure category in the state budget, with “capitation payments" representing roughly 64% of Medicaid benefit expenditures. The state contracts with Deloitte Consulting for Medicaid system maintenance and support services, and in 2021 approved a $99 million contract to run until June 2024. Deloitte has been paid approximately $455 million between fiscal 2019 and March 22, according to the state’s spending data portal. Bergantino said the goal of the annual audit is to identify noncompliance with federal regulations and to provide recommendations where corrective actions are needed "to ensure the efficient administration of federal benefit programs." “For large and complex programs like Medicaid, identifying and correcting deficiencies in system processing is critical to ensure compliance with federal regulations and to improve program controls over time," he said. Bergantino noted that estimates included in the report were determined by using a weighted average of identified ineligible payments and that the actual number could be higher. A previous audit of 14 states released by the U.S. Office of Inspector General identified more than $249 million in unallowable Medicaid capitation payments made to managed care organizations on behalf of deceased people between 2009 and 2019. Christopher Allen is a PBN staff writer. You may contact him at Allen@PBN.com.