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April 17, 2014

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Audit finds state improperly paid some Medicare subsidies

Sun coverage

Nevada failed to adequately vet seniors and the disabled who get a state subsidy to help pay their Medicare premiums, potentially costing state and federal taxpayers millions of dollars, according to a federal audit.

Nevada will have to pay back $180,000 to the federal government for not deleting individuals from the rolls even after they had been determined to be ineligible. The federal government will withhold another $900,000 to the state until there's further review of some cases.

Another $72.8 million is under scrutiny because the state did not have adequate documentation to provide to auditors, according to the report by the Office of Inspector General.

“The state agency did not verify the eligibility of individuals added ... or take corrective action on erroneous public welfare additions,” according to the audit, which was released last month.

Since the auditors’ initial investigation in March, the state has improved its monitoring of those it subsidizes and its communication with federal agencies, said Charles Duarte, the state administrator who oversees the Medicaid programs.

The state agency strongly disputed the $72.8 million questioned in the audit.

Duarte, in an interview Wednesday, described the figure as “very preliminary and probably inaccurate.”

The agency, in a response to an initial draft of the audit, petitioned to have that number taken out.

“An outside reader of the report may believe that there is potential for the entire $72.8 million ... to be disallowed,” according to the state’s response to federal auditors.

Duarte said that since the report, state officials recovered the documents auditors had labeled as missing. Those files had been deleted because they had already been electronically transferred to the federal agency.

The state hired a company to help look into the records and develop better procedures.

Nevada, through Medicaid, provides about 45,000 seniors and disabled clients with a monthly subsidy of just under $100 to help pay premiums for Medicare, the federally run health care program.

The audit looked at records in Nevada from late 2007 to the middle of 2009. In one finding, the audit discovered seven of 18 subsidies had been wrongly paid.

States are responsible for “verifying the validity of public welfare additions” and correcting errors to the welfare rolls, according to the Centers for Medicare and Medicaid, the federal agency that oversees those programs.

Of the $74 million spent on the subsidies in less than two years, $45 million was in federal money.

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  1. Tip of the iceberg. State Dept of H&HS is NOT verifying applicant eligibility for ANYTHING. No auditors with real-world training and expertise--just the close personal friends of executives.

  2. 7/18 is atrocious error rate. more than a third PAID OUT IMPROPERLY. H&HS is almost as costly as K-12. Let's DO SOMETHING about fraud, waste and abuse in state programs BEFORE discussing revenue levels.

  3. I completely agree with Roslenda. Don't dare try to tell us we have deficits because we don't pay enough in taxes.....cut the waste, fraud and overspending!

  4. H&HS is supervised and managed by apparently INCOMPETENT MANAGEMENT. We have a few too many close personal friends promoted into management who are INCAPABLE of administering federal grants. A year of two as an in-house "auditor" does NOT qualify one to be a section CHIEF and administer a program that must have serious internal controls to PRECLUDE FRAUD, waste and abuse.

  5. fedup2,

    You could hire people, but I would recommend you have a personnel management practice in place from day one and the new employee reads and signs off on them.

    An employment policy with expectations, a probationary period, and a regular scheduled job performance review, with improvement recommendations clearly issued, with expectations, and suspension and/or termination outcomes for non-compliance documented.

    That doesn't prevent you from being a great employer, and treating your employees well. Employees need to meet the expected standards. If not, the employer should honestly review them to determine if they are realistic.

    In fact, I encourage very good treatment and respect to ensure you get receive the same, in addition to productivity.

    These practices can prevent you from being taken advantage of by unscrupulous workers.

    You must be consistent, fair and reasonable, whether you have one employee or 100. A fact of doing business.

  6. I would be interested in knowing if state auditors work under a productivity quota. Also, what are the staffing levels compared to the amount of work to be done?

    Sometimes quotas can be counter productive because they set the employees up for having to do things they would rather not do in order to meet the quotas and keep their jobs. That is wrong.

    The results are often bad, because those quota's are often greater than is possible to reach by most, resulting in shortcuts or other negative actions.

    The people that work out quotas, with all their formulas and statistics are not the people doing the work. I have seen so much damage done as a result of the quota setters, including loss of money for the employer. It is a real problem in so many industries.

    Most who works under quotas can understand, and anyone who buys products today can attest to the loss of quality, no matter where it is made.

    This problem happens in healthcare alot, both private and public, with under staffing and excessive productivity quotas, and this can be very costly to patients and profits.

    It would be more cost efficient and have a higher quality outcome to establish reasonable production standards that are not so heavily weighted toward increasing profits or cutting down on payouts.

    It would also result in more honest budgets.

    Hiring adequate staff may cost more, but result in better quality. It also puts people to work and thus buying products and services, and paying taxes.

    This doesn't mean there cannot be reasonable expectations and processes, including adequate training, that are geared to helping good employees do the best job possible.

    Employers and employees should not be in an adversarial relationship, they should be a team with a common goal related to the service or work they provide. That requires respect, listening and working together to find ways to accomplish goals, by both sides.

    Unfortunately, the problem is often attacked in ways that don't solve the problem, but makes it worse. We all pay for that in the end in some way or other.

  7. HomeBoy: MAABD is Medical Assistance for the Aged, Blind, Disabled--the sum total of what Nevada "does" for these people is pay that part B premium. There are endless programs for large families but next to nothing for adult disabled.... And is it asking too much for H&HS to monitor APPLICANT ELIGIBILITY? What about I.D. theft amongst the endless illegals taking TANF, Food Stamps, local housing assistance, Child Care assistance, LIHEA utility assistance? NOTHING IS BEING DONE to ensure applicant eligibility. If the feds or other auditors had any way of sampling I.D. / SSN qualifications--dead people's SSN's, cousin's SSN's, made-up SSN's used to claim benefits. If ever they find applicant ineligibility all they do is cancel future benefits and DO NOTHING TO COLLECT OVER PAYMENTS MADE DUE TO FRAUD. H&HS has not asked for legislation to enable enforcement or compliance with federal programs. Instead they keep asking for more tax money to spend.