Audit: UPMC program cost taxpayers $350K due to reporting delays, $120K not able to be recovered
A University of Pittsburgh Medical program cost taxpayers more than $350,000, according to findings by Pennsylvania's Auditor General.
According to those findings, UPMC failed to update participant information per a contract between the Community HealthChoices program and Pennsylvania's Department of Human Services.
The failure allegedly cost taxpayers more than $350,000 in 2022. Of that money, $120,000 is not able to be recovered due to contractual restrictions.
The Community HealthChoices program is a health insurance program for residents who are 21 and older that "receive long-term supports through Medicaid and Medicare or who receive long-term supports through Medicaid because they need help with everyday personal tasks," according to DHS.
It covers physical health services, home and community-based services, and nursing facility services for more than 450,000 Pennsylvanians.
“UPMC is required to report to DHS whether a person has died, went to jail or is no longer eligible to be part of the program,” Deputy Auditor General for Audits Gordon Denlinger said. “DHS uses this as part of the data to set the rate it pays UPMC to provide care to people on Community HealthChoices."
UPMC allegedly did not notify DHS when there were changes to a participant's eligibility in the program.
According to the Auditor General, DHS overpaid by $357,048.
Denlinger said the office recommends contract language be changed to make sure UPMC contacts all those participating in the program once a year to make sure their status hasn't changed.