Tennessee unnecessarily paid out $1.47 million in health benefits during 2012 for 24 people whom state auditors say weren’t eligible to be in the state’s high-risk health insurance pool for the uninsurable, reports Andy Sher.
Twelve enrollees were found to be eligible for the federal Medicare program for seniors and thus shouldn’t have been allowed to join the state’s AccessTN program, which serves those unable to find health coverage, the audit states.
The audit, performed by Comptroller Justin Wilson’s State Audit Division, examined a number of programs and procedures in the state’s Department of Finance and Administration.
Among them was the effectiveness of state oversight of eligibility verification in the state’s AccessTN program, which is administered under contract with BlueCross BlueShield of Tennessee.
AccessTN in 2011 was transferred to the state’s newly created Division of Health Care Finance and Administration.
Auditors reported that with minor exceptions, the state properly monitored and reconciled BlueCross’ claims data and amounts reimbursed to BlueCross.
But in examining the state’s monitoring of Blue Cross’ overall administrative services, auditors performed an independent comparison of 60 of 3,092 AccessTN members for March 2012 and all members over age 65 for April 2012.
It was there they said they discovered several problems with state oversight in the eligibility determination area.
“We found that the Cover Tennessee office had not established policies and procedures to periodically review [BlueCross'] eligibility determinations to ensure that BCBST complied with AccessTN’s eligibility requirements,” the audit states.