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Despite ‘staggering’ success, Illinois drops Medicaid fraud finder

By   /   November 26, 2013  /   No Comments

By Benjamin Yount | Illinois Watchdog

SPRINGFDIELD, Ill. — Illinois is rewarding a private company that has found more than 200,000 people who should not be enrolled in Medicaid by pulling the firm off the job.

Maximus, a Virginia-based company, has been combing through the 2.7 million people enrolled in Illinois’ Medicaid program.

GREAT JOB, YOU'RE FIRED: Illinois is limiting the private company that has scrubbed the state's Medicaid rolls.

GREAT JOB, YOU’RE FIRED: Illinois is limiting the private company that has scrubbed the state’s Medicaid rolls.

So far this year, the company has reviewed 465,076 cases, and recommended that 228,965 people — about half — be dropped from the Medicaid rolls. Illinois has removed 114,675 people from Medicaid, and kept 176,664. The remaining cases are pending.

READ THE REPORT HERE

But Maximus time on the job is coming to an end.

A six-page memo from Oct. 31 states that the state’s Healthcare and Family Services agency as well as the state’s Department of Human Services will stop using Maximus and will turn over the Medicaid review to unionized public employees.

READ THE HFS MEMO HERE

“HFS and DHS are have determined that it is possible to make the process more efficient by eliminating the step of Maximus eligibility workers making a recommendation, so that the case goes directly to a State caseworker,” states the letter from Michael Koetting, HFS’ deputy director of Planning & Reform Implementation.

The move satisfies the order of an arbitrator who ruled that public employees, most represented by the American Federation of State, County and Municipal Employees, are required to do the same job that Maximus has been successfully working at for more than a year.

“HFS and DHS have filed an appeal to (the arbitrator’s) decision,” the letter states. “But in the meantime (HFS and DHS) have determined that the more sustainable course of action is to amend the agreement with Maximus to streamline the redetermination process.”

State Rep. Patti Bellock, R-Hinsdale, said Maximus is doing exactly what lawmakers hired them do to, and she questions the need to cancel their work.

READ BELLOCK’S LETTER HERE

“This has been a major success. We’ve told Gov. Pat Quinn ‘Don’t take it away’,” Bellock told Illinois Watchdog.

KEEP THEM WORKING: Bellock is pleading with the governor to keep Maximus on the job.

The state downplays the move to strip Maximus.

“No administration has done more to root out waste, fraud and abuse in the Medicaid program than the Quinn Administration.” Mike Claffey, Illinois’ healthcare spokesman, said in an emai, reiterating that Maximus was clearing the low hanging fruit from the state’s Medicaid rolls.

“The vast majority of these were canceled because the client did not respond to a request for verifying information about their income or residency,” Claffey said. “We believe this rate will come down, however, because the review started with cases that had been flagged for various reasons, such as a discrepancy in the data.”

Bellock said a 50-percent cancellation rate is not just about people who are not responding to letters.

“We’ve removed more than 50,000 people. That’s not just low hanging fruit,” Bellock said.

Bellock has written a letter of her own to the governor, pleading with him to allow Maximus to continue its work.

Jonathan Ingram, a senior fellow at the Illinois Policy Institute, said Illinois did a terrible job checking Medicaid eligibility before Maximus took over.

“As the Auditor General reported earlier this year, the problems were so bad that in many cases, state workers weren’t collecting paystubs, weren’t verifying Social Security numbers, citizenship status or residency and in some cases, the annual eligibility checks had been delayed for more than five years,” Ingram said.

But Illinois is moving ahead with the plan to once again have state workers take over.

HFS expects to hire 200 employees and open two “substantial” centers to handle the work Maximus is doing.

Contact Benjamin Yount at Ben@IllinoisWatchdog.org and find him on Twitter @BenYount.

 

 

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