A program established to save money on state-provided health insurance has been grossly mismanaged, according to a state audit, costing the state thousands of dollars.
How much mismanagement of the Health Insurance Premium Payment Program cost the state is uncertain. The program administered by the Nebraska Department of Health and Human Services has spent more than $6.5 million the past couple of years on private health insurance for 661 recipients. The audit examined 70 cases and discovered errors in more than 50.
State Audit Mike Foley blames a poorly trained state worker for the mismanagement of the program that is supposed to shift people from Medicaid to private insurance, if it can be found to be cheaper.
“The documentation was sorely lacking in many of these cases. The files were rather thin, because the person processing those payments wasn’t requesting the proper documentation to prove that it was cost-effective,” Foley told reporters in a news conference in his Capitol office. “She wasn’t doing those kinds of tests to prove it was cost-effective to handle the medical needs this way as opposed to the more traditional Medicaid program.”
In one case, according to the audit, DHHS paid more than $265,000 in private health insurance premiums though it would be much less costly to keep the person on Medicaid.
Foley says the audit also indicates that some might have taken advantage of the program to defraud the state.
“We did find instances of people who are participants in the program presenting requests for reimbursement for costs that didn’t ever occurred,” Foley stated. “Now, did they do that with intent or what as the motivation? I don’t know, but I think that something that someone in law enforcement needs to take a look at.”
DHHS agrees with much of the audit’s findings.
DHHS CEO Kerry Winterer promises an overhaul of the program. He says the person overseeing it has been replaced and a supervisor has been assigned to double-check the work done on the program.
Winterer said the department will review all the cases. In some instances, recipients might be required to reimburse the state for overpayments.
Click here for a link to the full audit.
AUDIO: State Auditor Mike Foley discloses results of an audit of HIPP. [11 min.]
AUDIO: DHHS CEO Kerry Winterer reponds to state audit. [3:33]
AUDIO: State Medicaid Director Vivianne Chaumont reacts to state audit. [4 min.]