A recently released audit from the U.S. Interior Department on the Medicaid program in the territory identified shortcomings that resulted in monetary errors of $85,312.
Of that amount $60,818 was in erroneous personnel charges to the program, the audit released Monday revealed.
In one instance cited, a former employee of the Medicaid program was transferred to another non-Medicaid related job, but the payroll costs, along with an undetermined amount of fringe benefit costs, continued to be charge against Medicaid program funds to the tune of $56,837.
The audit also uncovered a failure to properly document two contract workers' hours. The consultants were paid $45 an hour and $26.08 per hour for working 10 hours per week and 12 hours per week respectively. However, the auditors observed the $45-per-hour consultant putting in 4.5 hours instead of the 10 hours being paid for and the worker making $26.08 was observed working only nine hours per week, instead of the 12 hours charged to the program.
When local program officials were queried about the discrepancies, the auditor was told the consultants sometimes worked via telephone from their homes. However, there was no substantiating documentation to support the claim.
Fraud and ineligibility accounted for another $23,325 in questioned costs. Under the Medicaid eligibility terms, recipients cannot have more than $1,500 in cash resources.
In one instance a recipient was found to have $56,400 in a bank account and also owned rental property.
There is no system in place, according to the government's response, to remove an ineligible recipient from the master list until a new computer system is put in place sometime in Fiscal Year 2000. The V.I. government also blamed staffing shortages for the problems in conducting proper eligibility certifications.
Health care providers were working under contracts that had been negotiated, in some instances, as long as 10 years ago, the audit found. Of the 25 providers who were identified as care providers only six had executed health-care provider agreements for the current year and only five had submitted documentation evidencing the current status of their health-care licenses or certifications.
The audit also determined that equipment purchased under the program – a refrigerator, microwave and video player – were not pertinent to the operation of the program. The government disagreed with that determination.
The Medicaid program as it applies in the Virgin Islands has long been criticized by health officials and community leaders for being extremely unfair and costly to the territory. In an addendum requested by the executive director of the program to reflect findings in an issue paper drafted by the program director in February, it was stated that the V.I. Medicaid program spent about $670 per Medicaid recipient compared to the national average per recipient of $3,311.
