AUDIT SHOWS TROUBLED ‘ALL KIDS’ PROGRAM
An annual audit of the state’s taxpayer-financed All Kids health insurance program shows the departments in charge of administering the program continue to struggle to implement previous audit recommendations.
According to the Auditor General’s office, a yearly review of the All Kids program showed ongoing internal administrative issues relating to eligibility determination, documentation of immigrants, nonpayment of premiums, data collection, and more.
Audit findings show the Department of Healthcare and Family Services (HFS) and the Department of Human Services (DHS) have failed to address situations wherein:
• In Fiscal Year 2010, 414 individuals received 2,543 services totaling $126,092 after the month of their 19th birthday, at which point they were not eligible for coverage. HFS and DHS are currently working to implement an eligibility system to improve the accuracy with which they make eligibility determinations and redeterminations.
• In Fiscal Year 2011, 315 individuals appeared to be enrolled with more than one identification number.
• HFS continued to incorrectly categorize “documented immigrants” as “undocumented.” Because the Department incorrectly classified 11,130 enrollees with Social Security numbers as “undocumented,” the state did not submit or receive federal matching funds for these misclassified documented immigrants. In Fiscal Year 2010 and 2011, undocumented immigrants made up 65 percent of the total payments for the expanded All Kids program.
• HFS failed to terminate All Kids coverage when enrollees failed to pay premiums on time.
• A previous audit showing ineffective controls of optical claims resulted in optical providers billing for multiple frames and fittings for the same recipient during the year. In one case, a provider billed for 180 frames and 186 fittings for 41 recipients in one fiscal year. HFS is still working to address this situation.
PREVIOUS RECOMMENDATIONS IMPLEMENTED
The Auditor General noted that HFS and DHS did incorporate previous audit recommendations targeting All Kids policies and procedures. The departments’ changes were found to have reduced confusion, and addressed instances of conflicting or duplicative information and directions.
According to the Auditor General’s report, in Fiscal Year 2011 more than 97,000 kids were enrolled in the expanded All Kids program instituted by Governor Rod Blagojevich and legislative Democrats. The program serves uninsured children who were not covered by the state’s previous KidCare program, extending health insurance benefits to children whose family income exceeds 200 percent of the federal poverty level or who are undocumented immigrants.
UNEMPLOYMENT SCAMS IN PRISON
For some Illinois inmates, committing crime outside prison walls isn’t enough—according to the Illinois Department of Employment Security (IDES), many have illegally collected nearly $2 million in unemployment insurance claims while behind bars.
According to IDES, more than 1,100 prisoners have fraudulently claimed unemployment benefits during the last two years. The agency discovered the fraud by comparing lists of individuals collecting unemployment benefits with inmate rosters from the Illinois prison system.
The worst offender was a prisoner in the Cook County Jail who collected $43,000 in bogus benefits.
How did this happen? Just what exactly is required for an Illinois resident to receive unemployment benefits? Who is responsible for checking the background of people who file claims for unemployment?
How did 1,100 inmates improperly collect more than $2 million in unemployment benefits?
This is just the latest in a series of “running the government” missteps by the current Administration. Whatever the reason, this serious lapse of oversight has resulted in a misuse of taxpayer dollars. One or two cases of fraud could conceivably slip through a system, but 1,100 inmates being approved to receive unemployment signals a serious systemic problem.
People collecting unemployment benefits have to certify every two weeks they’re eligible. Maybe it’s time for IDES to reevaluate their procedures and set up guidelines that will discourage this kind of fraud.
It’s good to see the Illinois Department of Employment Security has a plan to try and recoup some of the money, but this might be a case of closing the barn door after the livestock gets out.
The Department should also prosecute these inmates to the fullest extent of the law, and send a strong message that this type of fraud will not be tolerated.
ASSOCIATED PRESS QUESTION QUINN TIES TO FIRM
Governor Pat Quinn’s decision to award one of six coordinated care contracts to a politically-connected firm is raising questions and concerns among advocates for nursing home residents, according to the Associated Press.
The Quinn Administration announced October 16 the selection of six partnerships to launch the state’s transition to expanded coordinated care by 2015.
Although DHS said the selections were based on “ability to offer a holistic approach to delivering coordinated care to special populations,” the Associated Press reported that MADO Management, whose owner is a longtime contributor to Governor Quinn and other Democrat officeholders, was among the partnership entities.
The company is listed as a partner in “Be Well Partners in Health.” The group is to improve health outcomes for adults with severe mental illness and chronic health conditions, including substance abuse, on the north side of Chicago.
However, Wendy Meltzer of Illinois Citizens for Better Care, told the AP that MADO has no track record of helping nursing home residents with severe mental illness live more independently, and at least one of the company’s Chicago homes has received a below average rating on a federal nursing home comparison Web site.
MADO is owned by Peter O’Brien, who also chairs the Illinois Capital Development Board, which oversees state construction projects. He was appointed to the position in 2011 by Governor Quinn. According to the AP, O’Brien is the brother of the late Daniel O’Brien, Jr., a Chicago Democrat who served in the Legislature.
According to the Illinois Campaign for Political Reform, from 1993 through 2008, Mado Management gave $387,054 to Illinois Democrat candidates.