March 11, 2019

Audit identifies 77 ineligible dependents on city’s health plan

HBJ File Photo
HBJ File Photo
Hartford City Hall at 550 Main St.

An audit of the city of Hartford's healthcare program found 77 employee dependents that were not eligible to use its medical benefits package.

The audit, administered by the city's internal audit commission and conducted by California-based management consultant Secova Inc., will save the city $492,000 in healthcare costs by removing dozens of ineligible ex-spouses and children from the health plan, according to city officials.

Secova said about 3.1 percent of the city's health program members were deemed ineligible through the audit, which is below its average ineligibility rate of 5 percent to 6 percent for government entities.

Secova reviewed all claims paid by the city's insurers and prescribers and issued a report on its findings in January.

It found 77 dependents -- 46 children and 31 spouses -- that were not verified as eligible under the city's health plan. Employees dropped 51 dependents when asked to submit eligibility documentation.

The results show 13 employees did not remove their divorced spouses from the city health plan as required. Eight of those dependents incurred claims of $237,000, with one retiree's ex-spouse accounting for about $208,000 of that amount since their divorce.

Secova flagged the ex-spouses after they were unable to submit necessary documentation or failed to provide sufficient dependent eligibility documentation. Other dependents were voluntarily ousted by employees as a result of the investigation.

The auditors were unable to locate divorce records for 11 spouses that incurred claims worth about $171,000, and those dependents were referred to the Hartford Police Department who may be able to locate the documentation, officials said.

The report said 19 employees and their dependents were referred to the police department for investigation and possible criminal prosecution for insurance fraud.

In total, Secova said removing 77 dependents from the health plan will save the city an estimated $691,000. However, after assuming a projected 30 percent reinstatement percentage, it expects the city to save approximately $492,000.

The city's Department of Human Resources recommended in June 2016 that the city perform a healthcare dependent eligibility audit related to medical, dental and prescription drug benefits provided for employees, retirees and their respective family members.

The audit required 1,191 active and retired employees to comply with the audit. Their health plans covered 2,559 dependents.

In the 2017-18 fiscal year, the city paid healthcare claims of $47.4 million and $1.5 million in administrative fees.

Secova has performed several audits for the city, including a recent investigation into ex-spouses of Hartford Board of Education employees.

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