California Spent $4 Billion in Health Care for "People Who May Not Have Been Eligible"

Wednesday, October 31, 2018

The California  Department of Health Care paid $383,000 in health care payments for a person that died in 2013 - the monthly payments ended in August 2018.  According to the audit, the Department of Health Care ‘should have known they were no longer in need of services.’ 

California spent $4 billion on health care for “people who may not have been eligible.”

From the Los Angeles Times:

…The audit found 453,000 beneficiaries who were marked as eligible in the state’s system, but not in the counties’ — indicating that they may not have actually been eligible for Medi-Cal. These beneficiaries may have died, moved or begun making more money and no longer qualified for Medi-Cal.

Yet the state’s Department of Health Care Services paid $4 billion to health plans and doctors for those patients’ medical care over four years. The audit found that 57% of the discrepancies lasted for more than two years.

In one instance, a Los Angeles County resident died in December 2013, yet the state continued to make monthly payments to the beneficiary’s Medi-Cal health plan until August of this year. The state ultimately paid the plan $383,000 for a person who the state “should have known was no longer in need of services,” according to the audit….

The audit recommended that the department implement a better system by the end of the year and recover erroneous payments by June. The department said it agreed with the recommendations but could not comply with them within that timeline.

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