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Audit Finds 60% of Medicaid Recipients Improperly Enrolled

Updated: Friday, September 13 2013, 11:55 AM CDT

Lawmakers created the Illinois Medicaid Redetermination Project back in 2012.

The project hired a private company, Maximus, to review Medicaid enrollments to see how many were receiving the wrong benefits, or shouldn't even be enrolled.

"I think if we go back to the root of the problem," says Republican Representative Raymond Poe, "is for the last several years, we don't have a recertification process, they mail a letter out, if you don't send it back, you stay on the rolls, we don't have a fraud investigation division no more, and so we've got several years of these things piling up."

According to the Illinois Medicaid Redetermination Project's most recent report...

out of 275,867 enrollments checked so far, 136,143 were recommended to be cancelled, and 30,969 received recommendations to change the enrollment.

That amounts to 60.5% of the enrollments.

"It shows the amount of fraud that's going on," says Republican Representative Rich Brauer, "we're looking at around 70%, and we're talking about a program that went in 5 years from 7 billion, to 15.5 billion, from an 8th of our budget, to a quarter of our budget."

The Department of Healthcare and Family Services has the final say on the enrollments.

So far the agency has acted on 190,756, determining that over 75,000 should be cancelled, and 27,377 changed.

That still amounts to 54% of the enrollments.

"I think the numbers are very accurate," says Brauer, "we had that legislative audit commission hearing the other day, and it was startling quite frankly that there is so much fraud, and it shows the need for it to continue even at a faster rate."

Illinois residents may not be surprised by the project's findings

"I think that they give the wrong people benefits, and not the right people," says fast food worker Jennifer Cronister, "and it's not fair to people like myself that work."

"I think if I had a 70% fail rating in my job," says Chuck Howell, who works in construction, "I wouldn't have a job, so."

AFSCME has filed a challenge to the hiring of the outside company to do the work.

We received a statement from AFSCME spokesman Anders Lindall that states, "The backlog in Medicaid eligibility redetermination was caused by a lack of caseworkers in the Department of Human Services. But rather than hire caseworkers, the state entered into a $77 million contract with a private company whose work has been slow, full of errors, and inefficient. DHS should simply hire the caseworkers it needs to bring the work in house and save taxpayers $18 million a year."

An arbitrator ruled in favor of the Union earlier this year, and a Legislative Hearing in Chicago will look into the matter next week.
Reporting in Springfield, Mike Brooks, NewsChannel 20.

Audit Finds 60% of Medicaid Recipients Improperly Enrolled

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