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Audit: UPMC program cost taxpayers $350K due to reporting delays, $120K not able to be recovered

Audit: UPMC program cost taxpayers $350K due to reporting delays, $120K not able to be recovered
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      PAUL VAN OSDOL PITTSBURGH’S ACTION NEWS FOUR. ALL RIGHT. THANK YOU, PAUL. THE AUDITOR GENERAL’S OFFICE FOR PENNSYLVANIA SAYS UPMC COST TAXPAYERS HUNDREDS OF THOUSANDS OF DOLLARS FOR NOT UPHOLDING ITS RESPONSIBILITY TO A STATE AGENCY. THIS WAS FOR UPMC COMMUNITY HEALTH CHOICES, WHICH IS A HEALTH INSURANCE PROGRAM FOR THOSE WHO RECEIVE LONG TERM SUPPORT THROUGH MEDICARE AND MEDICAID. A PERFORMANCE AUDIT FOUND UPMC WASN’T CHECKING IN ON PATIENTS ENOUGH TO MAKE SURE THEY STILL QUALIFIED FOR THE PROGRAM, AND SAYS IT DIDN’T LET THE DEPARTMENT OF HUMAN SERVICES KNOW IN A TIMELY MANNER. WHEN PATIENT STATUS IS CHANGED. UPMC SERVED OVER 140,000 PEOPLE THROUGH THIS PROGRAM IN 2022, AND RECEIVED ALMOST $360 MILLION IN PAYMENTS FROM THE STATE. THIS AUDIT ONLY LOOKED AT A SMALL PORTION OF THOSE PATIENTS. JUST 66, AND FOUND THESE ERRORS. THE AUDITOR GENERAL’S OFFICE SAYS THIS SUGGESTS THE STATE COULD BE OVERPAYING BY EVEN MORE. WE FOUND INSTANCES WHERE DHS PAID UPMC FOR PEOPLE ENROLLED IN THE CHC PROGRAM WHO WERE DECEASED, WENT TO JAIL, OR WERE NO LONGER ELIGIBLE FOR THE PROGRAM. THIS RESULTED IN AN OVERPAYMENT FOR SERVICES. THE AUDITOR GENERAL’S OFFICE SAYS UPMC AGREED WITH ITS RECOMMENDATIONS TO TAKE GREATER ACCOUNTABILITY IN MANAGING THAT PROGRAM. HE ALSO SAID DHS HAS SOME RESPONSIBILITY IN THIS TO MAKE SURE IT IS GETTING INFORMATION IN A TIMELY MANNER AND MAKING SURE PENNSYLVANIAN
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      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.

      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.

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      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.