U.S. Dept Of Health And Human Services Audit – One America News Network

OAN Staff Brooke Mallory
6:09 PM – Tuesday, February 25, 2025

A recent audit by the U.S. Department of Health and Human Services has found that the state of Colorado paid insurance companies over $7 million to provide care for deceased Medicaid recipients.

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Medicaid has become a hot topic in recent weeks. Around 80 million Americans utilize Medicaid, which is for individuals or families with low incomes and resources, such as children, pregnant women, elderly persons, and people with disabilities.

Colorado reportedly paid insurers at least $7.3 million for services for deceased Colorado citizens, including around $3.8 million in federal funds, according to a report from the Office of the Inspector General at the U.S. Department of Health and Human Services.

These were capitation payments, which give providers a specific sum for each enrolled person for a predetermined time period, whether or not the person uses the medical services.

According to the report, Colorado officials did not know whether a Medicaid enrollee had passed away since it lacked an automated method to monitor for deaths, even though data from the Social Security Administration’s Death Master File indicated this in most cases.

However, in several documented cases, the state processed the compensation even though it knew about the death, Newsweek reported.

The report continued, stating that Colorado started using an automated payment system in 2019 and made an effort to recover payments it shouldn’t have made. Nevertheless, payments issued to individuals who were designated as no longer eligible for Medicaid were not collected.

“In some cases, the state unenrolled a recipient for failing to return paperwork, even though the person had died, and it did not recover amounts sent out before they were unenrolled,” the outlet continued.

Three of the terms proposed as a result of the findings have been accepted by the state.

However, a Colorado Department of Health Care Policy and Financing representative refuted several of the report’s allegations — arguing that inspectors relied on federal and state records instead of contacting members to confirm their survival.

“Based on the OIG’s inadequate approach in reaching the financial estimates in this report, HCPF will need to spend time disputing the estimates directly with the Centers for Medicare and Medicaid Services, rather than attempting to identify and recover unallowable capitation payments,” stated Colorado Department of Health Care Policy and Financing spokesperson Marc Williams.

“We disagree with the State agency’s comments that our audit work was ‘inadequate’ and did not provide ‘true verification of [our] findings.’”

An estimated $3.8 million and an additional $2.2 million for “other Medicaid expenditures that the State agency had previously overreported” are the amounts that the Office of the Inspector General has recommended Colorado pay to the federal government.