Health agency audit on $22 million overpayments finally released

Reese_ClydeA month and a half after The Atlanta Journal-Constitution requested an audit critical of UnitedHealthcare’s handling of the State Health Benefit Plan, the Department of Community Health came through with the taxpayer-funded document.

It was redacted by UnitedHealthcare, which DCH said is allowed by law to protect “trade secrets.” The AJC asked UnitedHealthcare to un-redact much of what the company blacked out, and DCH emailed new pages without the redaction on Friday.

What was not redacted contained little the AJC hadn’t already reported in October.

The AJC reported that DCH auditors found that the plan, managed by UnitedHealthcare, had overpaid almost $23 million for surgical assistants services. The audit also said there might be overpayments in other areas.

DCH Commissioner Clyde Reese said the company was in “breach of contract,” and the agency withheld payments to United. Blue Cross and Blue Shield of Georgia took over managing the plan this year.

However, DCH was under pressure this year from teachers and other plan beneficiaries to increase the number of companies running the plan. So in July, the state announced United’s return to the State Health Benefit Plan. A few weeks later, Reese settled the overpayment case with United, giving the company $7 million the state had withheld and promising not to investigate other potential past billing problems.

The overpayments were the largest of their kind, according to DCH officials. The State Health Benefit Plan covers about 650,000 teachers, state employees, retirees and their beneficiaries.

Even after the AJC reported on the overpayment issue, Reese’s legal department repeatedly delayed releasing the audit detailing the problem.

Georgia’s Open Records Act states that agencies “shall produce all records response within a reasonable amount of time not to exceed three business days of receipt of a request.

The legal department first said they were looking for the audit. Then they said they were reviewing it. Then they said they were looking for it again. And later, that they were still reviewing it.

Reese, a lawyer, pushed for the audit to be released once the AJC brought the department’s slow response to his attention last week.





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