Audit Finds Lax Monitoring of $7B in Illinois Medicaid Payments to Insurers

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Illinois Gov. Bruce Rauner’s administration cannot adequately account for more than $7 billion paid to Medicaid insurance providers in 2016, an audit released on Jan. 23 found.

The critical review by Auditor General Frank Mautino comes just weeks after the Republican governor ramped up managed care for Medicaid caseloads to the tune of $60 billion over four years.

It said the Department of Healthcare and Family Services “did not maintain complete and accurate information needed to adequately monitor” $7.11 billion in payments to or by the 12 managed-care organizations, or MCOs, that participated in the fiscal year that ended in June 2016.

The audit also found the department could not provide information to show all claims it paid to providers in 2016; the claims the providers denied; the providers’ administrative costs or the coordinated costs they incurred by splitting coverage with other providers; or the medical-loss ratios which show premium payments are covering claims.

It also highlighted that the agency made multiple monthly provider payments for the same months for the same 302 patients, totaling $590,000.

The newly minted expansion will improve program quality, HFS spokesman John Hoffman said.

“The department rebooted Medicaid managed care to ensure program integrity and accountability, protecting taxpayer dollars while providing quality care for those with limited re