AP NEWS

Insurance audit discovers six potential ineligible members

January 12, 2019

Commissioners heard a report from County Treasurer Kim Harris, who also supervises the Human Resources department, that detailed the results of a dependent eligibility audit with the county’s self-funded insurance.

On April 10, 2018, the court approved PlanSource to conduct the audit with a mission of verifying that every member on the plan was eligible for the coverage.

The consequences for those who were ineligible was termination from the plan and the possibility of recovery of any expenditures on their behalf.

“I feel like the audit went well and it accomplished what we’re trying to do,” Harris said.

Since the county insurance is self-funded, Harris and commissioners wanted to avoid any type of fraud or misuse of the funds.

“Every dollar that is paid comes directly out of the county fund and is administered by Blue Cross Blue Shield,” the treasurer said.

“They pull money out of our bank account to pay those claims. No one wants an ineligible on the plan because every penny is important to keep in that account,” she said.

Harris had some concerns with the report from PlanSource and asked to extend the deadline.

“I think there was some confusion among some sets of employees regarding what they needed to get back to PlanSource. Some of them thought they had submitted everything to comply with the audit, but in fact, did not,” she said.

Harris said the deadline occurred in the middle of the holiday season on Dec. 18 and felt some might have missed the deadline inadvertently.

She reported that PlanSource mailed 200 letters to employees who had dependents on the plan.

Of those 200, 22 employees did not respond at all.

Some of those involved, she discovered, were employees who were dropping coverage anyway.

“Those really don’t need a response,” she said.

Another 29 had insufficient documentation, according to PlanSource.

A closer look showed that some of those excluded submission of a copy of the back of their driver’s license.

“That seems irrelevant to me and I think it would be mean-spirited to drop somebody from coverage because they submitted everything else but the back of the driver’s license,” Harris told commissioners.

Six members, or about 3 percent of those with dependents, were deemed ineligible.

“There are employees who agree that they have dependents who are ineligible on our plan who have opted to terminate their coverage (on their own),” Harris said.

Harris said she had just received the report the day before.

“Now that we have the list in our hands of the people who either did not respond, or had partial compliance with the audit, we can contact those people, and say ’Here’s the situation. This is what you need to do, this is your final chance, and if you don’t comply by whatever date the court chooses, you will be terminated from your coverage,” she said.

Harris asked commissioners for a 30-day extension beginning Jan. 8.

Commissioner Leon Wilson asked Harris to forward the names of those who were on the non-compliant list or those missing documentation to their supervisors for them to follow up with their employees to make sure the paperwork was completed on time and Harris agreed.

Outside of terminating the coverage of those who are ineligible on the coverage, commissioners also wanted to address reimbursement of expenditures on behalf of those who were not supposed to be on the coverage.

Harris didn’t recommend that but asked the court to address it since they asked for the audit.

In a motion by Commissioner Bruce Karbowski, the court excluded the reimbursement until the end of the 30-day extension.

Harris said she might change her mind on seeking damages on those who took the county funds as ineligible members.

“It depends on what I find in the final analysis on each of those,” she said.

“I haven’t done a complete review of the circumstances of the six ineligible dependents,” she said.

“I need time to review what the situation was and why they were on our plan and ineligible to begin with.”

Harris said it could be something as simple as not submitting any information or incorrect information, but she would spend the next few days investigating the circumstances.

Requirements for the insurance and adding dependents include a spousal affidavit, and providing a marriage certificate for the spouse, and even a birth certificate for claiming children on the plan. She said they try to do their due diligence in making sure only those that are supposed to be on the insurance are actual participants.

“This is a grace period, but at the end of that time, it may turn into a situation where we have to ask them to pay back claims,” she said. It would be a legal matter referred to County Attorney Matthew Poston.

In other court action, commissioners tabled action for reimbursing money as per an interlocal agreement to the city of Plum Grove for $1,434.60 until Commissioner James Reaves was present for the meeting. Commissioner Greg Arthur was also absent from the meeting.

The court also approved a preliminary plat for Encino Estates, Section 2. Plans were already submitted to LJA Engineering. Jay Wilkerson of Encino Estates said they have already sold out of Section 1 with 392 lots and Section 2 they have sold 100 more lots spoken with two builders ready to continue building.

dtaylor@hcnonline.com

AP RADIO
Update hourly