Here, with my bold-face highlighting, is an excerpt from the new report from the state Auditors of Public Accounts on the state Department of Social Services:
“Background: DSS contracts with two vendors to administer non emergency medical transportation for some recipients on the State of Connecticut Supplemental Benefits Program and Medicaid. The vendors receive a monthly capitated rate for each client regardless of whether the client is provided actual transportation. Under the State Supplemental Benefits Program, clients also receive monthly cash assistance.
DSS provided us with a monthly report of cases closed due to the death of recipients. We sampled clients listed on the June 2009 report to determine whether payments made after the death of the recipients were appropriate. This report had 686 names listed. Twenty-four of the names listed were clients of the State Supplemental Benefits Program.
Criteria: Section 1565.05 of DSS’ Uniform Policy Manual sets forth the ending date of assistance due to non-financial factors, including the death of a client. The manual provides that, when eligibility has been determined to no longer exist, the last day for which the assistance unit is entitled to the benefits of the program is the last day of the month in which a non-financial eligibility factor causes ineligibility, provided that eligibility existed on the first of the month. This includes the death of a recipient.
Condition: Our review of benefit payment histories of recipients listed on the Closed Cases by Death of a Recipient report for June 2009 disclosed the following:
1. For eight out of the 20 State Supplemental Benefits Program recipients tested, we noted that monthly benefit payments totaling $1,457 were issued after the their deaths. In all eight instances, receivables were not created so that the established procedures could be used to recoup the overpayments. There were excess payments made for one month in six cases and for two months in two cases.
2. In 20 out of 20 State Supplemental Benefits Program recipients tested, we noted that transportation payments totaling $680 were paid on behalf of recipients for services in the months following their deaths. DSS has not attempted to recover these overpayments. The number of improper monthly transportation payments consisted of excessive payments of three months in three cases, two months in four cases, and one month in 13 cases. The process for making capitated transportation payments under Medicaid is the same as the process used under the State Supplemental Benefits Program. However, it should be noted that a capitated rate would only be paid on behalf of some of the Medicaid clients listed on the June 2009 report.
Effect: Improper payments totaling $2,137 were made for which DSS made no attempt to recover.
Cause: For the improper monthly benefit payments, procedures were not followed to establish receivables in DSS’ computer system for these overpayments. For the improper transportation payments, DSS has not yet developed a process to recoup transportation payments that are made after the death of a recipient.
Recommendation: DSS should improve its procedures relative to cases closed due to death to ensure the discontinuance of benefit and transportation payments or the recovery of those payments issued after death. (See Recommendation 4.)
Agency’s Response: “We generally agree with the findings and recommendation. It should be noted that in 4 of the 20 cases reviewed, benefits issued after death of the client were subsequently wholly or partially expunged from these clients’ EBT (electronic benefits transfer) accounts. In one case, benefit checks issued after the death of the client were not cashed and became stale dated.”
Auditors’ Concluding Comments: In the four cases, the EBT accounts were expunged one year after the funds were deposited into the account. The computer system is programmed to expunge unused funds in the EBT accounts one year after the funds were provided.