Denver's self-funded health plan headaches continue as a recent follow-up audit by Denver Auditor Timothy M. O'Brien, CPA, shines an unflattering light on the city's management, or potentially the lack thereof, of healthcare benefits. O'Brien's findings suggest the city's pocketbook is still at risk of bleeding green due to spending on ineligible healthcare benefits. This, in an era where every dime and dollar should be justly accounted for, with public trust teetering on the not-so-sturdy railing of government expenditure.
O'Brien's team has put forth recommendations to help streamline the city’s self-funded health plan review process. Specifically, they're pointing towards the need to swiftly improve policies, institute formal procedures, and ensure strategic training for staff to stop ineligible employees and dependents from dipping their hands into the honey jar of government-funded healthcare benefits, according to the Denver Auditor's Office.
Moreover, UnitedHealthcare, one of the two carriers offering health insurance to city employees, is reportedly not sharing crucial cost data. Without this, the Office of Human Resources is in the dark on whether it's paying more than it should for services provided. “The city has a responsibility to provide benefits to eligible employees without also paying for services that people are not eligible to receive,” Auditor O’Brien said, as per the Denver Auditor's Office. "Better oversight processes will help the city save money."
The silver lining, if it could be called that, lies in the audit's uncovering of savings north of $2 million after ineligible dependents were removed from city coverage, a whopping $3,500 per dependent in found money. Yet, despite this win, Human Resources seems to have only partially implemented three of the initial audit’s recommendations, and three others remain unaddressed, leaving the proverbial door half-open, half-closed to financial wastage. The gravity of this oversight becomes weightier considering the bleak budget outlook for the city.
The audit's recommendations are not radical. They include creating and documenting procedures for regular dependent eligibility reviews and pressing forward with a medical claims audit to understand if the taxpayer dollars are achieving their highest and best use. “Once the office improves its monitoring of ineligible healthcare recipients and develops a documented process for preventing improper benefit enrollment, we will be more confident taxpayer dollars aren’t wasted,” Auditor O’Brien told the Denver Auditor's Office.
