- The Washington Times - Tuesday, February 10, 2004

The failure of D.C. Healthcare Alliance officials to perform routine eligibility checks of people enrolled in a city-funded health plan has cost D.C. taxpayers millions of dollars since 2002, a recent audit found.

The city’s Healthcare Alliance program paid out $13 million in 2002 and 2003 for health services to residents already eligible for Medicaid, according to a finding of the D.C.-based accounting firm KPMG LLP. Auditors forwarded the findings to the D.C. Office of Chief Financial Officer on Jan. 22.

“The Alliance did not perform Medicaid eligibility verifications, and the District’s monitoring of the Alliance’s invoices did not detect this,” the audit said.

The D.C. Department of Health oversees the city-funded health care plan for low-income residents who do not qualify for Medicaid — the federal government’s health care program for low-income people.

The audit findings prompted one D.C. Council member to criticize Chartered Health Plan Inc. — a privately owned health-maintenance organization — which the D.C. government has paid tens of millions of dollars since 2001 to perform eligibility checks and administer Healthcare Alliance claims.

“The contract calls for Chartered Health to screen for Medicaid,” said councilmember David A. Catania, at-large Republican. “They have breached their contract. Their failure to do what they were contracted to do has cost taxpayers millions of dollars.”

“It was a failure to do their job,” Mr. Catania said. “We should find somebody else.”

Chartered Health is owned by Jeffrey E. Thompson, a key political ally of Mayor Anthony A. Williams. Officials at Chartered Health did not return phone calls seeking comment yesterday.

However, Brenda Emanuel, deputy director of the Healthcare Safety Net Administration in the D.C. Department of Health, yesterday defended Chartered Health’s recent performance. She said the company has put reforms in place to make sure the Healthcare Alliance does not pay for health services for people already eligible for Medicaid.

“We have cleaned up the database and cleaned up the process,” Miss Emanuel said. “We do not pay for anyone who is currently enrolled in Medicaid.”

Chartered Health and the city’s health department began checking enrollees’ eligibility in March by sending Healthcare Alliance claims to Medicaid administrators, Miss Emanuel said. Since then, the Healthcare Alliance has rejected payment for health services to residents who already qualify for Medicaid.

Miss Emanuel said the city health department also is trying to recoup the $13 million that the Healthcare Alliance has already paid for services to individuals qualified for Medicaid reimbursement.

The KPMG audit also said that some health care providers who belong to the Healthcare Alliance may have submitted claims to both the Medical Assistance Administration and the Healthcare Alliance for payment for services.

“I guess that’s what the allegation is,” Miss Emanuel said in response to questions about health providers getting paid twice for the same service. “But that’s not what we’ve found.”

Mr. Catania said he doubts city officials will take any action to sanction Chartered Health. “Chartered’s relation to the mayor is such that there won’t be any heavy lifting,” he said.

Mr. Thompson has contributed heavily to Mr. Williams’ campaign and political causes, and he has won mayoral appointments to serve on oversight boards at the University of District of Columbia and Metropolitan Washington Airports Authority.

Chartered Health previously came under criticism from Mr. Catania and other D.C. Council members in January when The Washington Times reported that the health department had allowed the firm to limit the hours of a health clinic it operates in Ward 7.

The health department allowed the firm to close on Sundays and overnights during the week, months after it paid Chartered Health more than $1.8 million to provide 24-hour, seven-day-a-week services at its clinic at 3924 Minnesota Ave. NE.

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