Счетный комитет штата выявил переплату страховщикам на $9,6 млн из-за ошибок в учете

The state may be overpaying health insurance contractors as necessary safeguards to avoid this were lacking, a recent audit details. The Office of the State Comptroller Healthcare Policy and Benefit Services Division lacked a process to reconcile overpayment credits and adjustments to supporting documentation on monthly healthcare contractor invoices, auditors noted in a report released this week. Therefore, the division was unable to verify the total monthly credits were supported and applied correctly, auditors said. The audit, which noted three deficiencies in total, was conducted for fiscal years 2022, 2023 and 2024. Since the lack of reconciliation was first noted in a prior audit report, the division has established regular reporting with the state’s health insurance carrier to provide detailed reports regarding overpayments, the agency said in its audit response. “To date, the carrier’s reports are not sufficient for the level of detail required to directly align with the credit values associated with each invoice,” officials from the comptroller’s office said. Concerns have been addressed with the vendor and the agency is working on addressing this issue, officials said. Auditors also selected 26 payments to four health care contractors to review for accuracy, but were unable to verify the accuracy of 22 of them and their administrative fees totaling $9.6 million due to lack of proper supporting documents. This means the state could be overpaying for benefits and services, auditors noted. Agency officials noted that the administrative billing process varies by healthcare vendor, and that the enrollment data alone in the state’s system, Core-CT, does not capture the full enrolled population. However, the vendor has now been instructed to expand the monthly reporting to include participant identifiers, making it easier to reconcile and confirm the data. The third issue auditors highlighted was that the division booked two material journal entries incorrectly, which were not identified and corrected until the following fiscal year. “In fiscal year 2023, the division recorded a $12,908,709 payment to the wrong fund,” auditors said in the report, noting it was identified in 2024 and fixed in 2025. “In fiscal year 2024, the division incorrectly booked a transfer of $54,367,739 and adjusted it in fiscal year 2025.” OSC also failed to update the adjusting group life insurance fund balance for fiscal years 2024 and 2025, auditors said. Officials from the comptroller’s office said they partially agree with this finding, and that when the errors were initially identified, they established a process to include a second level review of all payment entries prior to submission. The agency also provided records of proper life insurance information being provided. Auditors concluded the office should work to improve communication between some of its internal divisions.