medicaid

Kentucky Audit Shows More Than $72 Million In Medicaid Potentially Going To ‘Ineligible Beneficiaries’

Progressives have a steadfast belief that it is impossible for illegal immigrants to receive taxpayer-funded government benefits because there are allegedly rigorous standards in place to prevent such a thing.

Unlike conservatives, who view the federal and state governments as flawed bureaucracies that employ generally well-intentioned but fallible people, progressives have a tendency to view federal and state governments as uniquely benevolent, near-perfect entities. As such, they are often reluctant to acknowledge fraud, abuse, and the failure to enforce legal regulations on the part of the state.

The Washington Free Beacon reports that “an estimated $72 million in Medicaid payments were made to potentially ineligible beneficiaries in Kentucky, according to an audit from the agency’s inspector general.”

Prior to a Kentucky resident gaining access to Medicaid befits, they are required to prove their citizenship. However, the audit reports that “human and system errors” may have led to $72 million going to ineligible beneficiaries. For this report, the auditors “selected a stratified random sample of 120 beneficiaries from a total of 901,117 beneficiaries,” conducted field investigations, and analyzed copious documentation.

The following is an excerpt from the report:

To properly verify citizenship or nationality status of beneficiaries enrolled in Medicaid, States must ensure that those individuals declaring to be citizens or nationals of the United States have presented satisfactory documentary evidence of citizenship or nationality…

For 7 of 120 beneficiaries, the State agency determined these beneficiaries eligible for Medicaid without maintaining documentation that it verified citizenship in accordance with Federal requirements. For these beneficiaries, the State agency submitted their citizenship status through the Data Hub or BENDEX for verification with SSA. However, the State agency could not provide documentation that it had received a citizenship verification response. The State agency indicated that, because of human error and system errors, it could not find supporting documentation…

The State agency did not always verify identity or maintain documentation from identity-proofing of beneficiaries. For 13 of 50 beneficiaries that applied using the State marketplace, the State agency did not verify identity during the application process or document that it had performed identity-proofing in accordance with Federal requirements.

Specifically:

For nine beneficiaries, State agency personnel completed the application either online or over the phone and did not verify identity. The State agency was unable to provide any documentation indicating that personnel followed Federal requirements to verify identity for these online or phone applications.

For four beneficiaries, the State agency either did not verify identity or did not maintain documentation of the verification because of Kynect system errors…

On the basis of our sample results, we estimated that during our 6-month audit period, approximately 8% of non-newly eligible beneficiaries in Kentucky were potentially ineligible, and approximately 3% of Federal payments were made to those beneficiaries. As a result, we estimated that Kentucky made Federal Medicaid payments on behalf of 69,931 potentially ineligible beneficiaries totaling $72,763,721.

We did not include the identity-proofing errors in our estimate of potentially ineligible beneficiaries and payments, but we are highlighting the potential for identity theft if the state agency does not correct these errors.

Even without including the identity-proofing errors, the estimated coverage of potentially ineligible beneficiaries is estimated to exceed $72 million dollars. That’s a substantial chunk of change. Moreover, the audit covered just six months in one state.

Using the Kentucky audit data to estimate Medicaid errors (both human and system-related) in other states is impossible. However, it is reasonable to assume that Kentucky isn’t the only state where human and system errors exist, leading to potential fraud and millions of wasted dollars.

The next time a progressive tries to tell you that allegedly rigorous standards prevent the wrong people from receiving government benefits, show them the audit data from Kentucky.

Source: Daily Wire

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