City is likely providing free health care to many nonresidents at a hefty cost

WASHINGTON (Map, News) - The D.C. government is likely paying millions of tax dollars to provide free health care to thousands of non-District residents who have managed to improperly enroll in the District’s medical safety net, documents obtained by The Examiner show.

An ongoing audit of the $129 million D.C. Healthcare Alliance by consultant Bert Smith & Co. found a “significantly high occurrence of individuals using the same address, raising concern of whether non-District residents may be enrolled in the program.” The Examiner obtained a draft of the audit.

The auditor also discovered multiple case records established for the same client and payments being made for individuals no longer enrolled in the program.

A review of 344 case files found the majority of recipients used unsubstantiated letters from relatives or friends as proof of their residency in the District.

The auditor also found that 16,720 of 63,167 Alliance data records contained no Social Security number, which may be explained by a large number of illegal immigrants in the program.

“I support universal health care, but universal to me means residents of the District of Columbia, not of the region,” said D.C. Council Chairman Vincent Gray, who has repeatedly raised red flags over the Alliance costs.

The District established the Alliance in 2001 to advance its goal of universal health coverage. The program, which faced a $40 million deficit last year, provides free care to D.C. residents who earn too little to afford private insurance but too much to qualify for Medicaid benefits.

The audit, which is nearing completion, has found that “some of the people determined eligible were not residents of the District,” Clarence Carter, director of the Department of Human Services, told the Council last week. He blamed an “antiquated automated eligibility program” and policy decisions that allowed for lax enrollment standards.

“There’s nothing that Bert Smith can say that we’re not already aware of and made recommendations to fix,” said Sharon Baskerville, executive director of the nonprofit D.C. Primary Care Association. “We continue to fix a bureaucracy that took on an innovative program that it didn’t have the infrastructure to manage.”

Participation in the Alliance has nearly doubled since June 2006 when the D.C. Income Maintenance Administration, which also enlists people in the food-stamp and Medicaid programs, was tasked with enrollment.

IMA’s policies might have opened the door to costly fraud, critics said.

People who declare themselves homeless, for example, are not required to provide any documentation to become Alliance clients.

The IMA is directed to enter its headquarters as the customer’s address.

In addition to the Bert Smith report, the D.C. inspector general is also auditing the program, which Councilman David Catania deemed “a work in progress.”

The cost of free health care for 50,000 people

» D.C. currently pays provider Unity Healthcare $212.21 per month per Alliance client.

» Managed-care costs for Alliance total roughly $127 million.

» Lower rates promised by Jan. 1, 2008, have not materialized.

mneibauer@dcexaminer.com

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