Suspecting Fraud, State Treasurer Dale Folwell Requires Proof of Dependents' Eligibility For State Health Plan | News
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Wednesday, May 24, 2017

Suspecting Fraud, State Treasurer Dale Folwell Requires Proof of Dependents' Eligibility For State Health Plan

Posted by on Wed, May 24, 2017 at 8:20 PM

If you’re employed by the state, you’ve likely received a letter informing you that you have until July 31 to prove your spouse is your spouse and your children are your children, or they will be dropped from the State Health Plan. The proof—tax returns, marriage and birth certificates, and/or adoption papers—must be submitted electronically. The letter recommends scanning the documents or taking “a photo with your smartphone” and uploading them to the State Health Plan website.

Here is the notice state workers received:

click to enlarge img_5915.jpg

One concerned state employee contacted the INDY, asking: “1) Is it really legal for them to demand and hold tens of thousands of tax returns, marriage certificates, birth certificates, and adoption papers? 2) How many examples of ineligible dependents do you think they will find? 3) How many families will find this difficult to manage and will have children or spouse suddenly barred from accessing benefits for which they have paid?”

On Wednesday, the INDY reached out to state treasurer Dale Folwell Wednesday to ask why he feels an audit is necessary—and why, while he hopes an audit will reveal zero cases of insurance fraud, he believes the numbers will be in the thousands, which translates to tens of millions of misspent dollars. And the fault, he says, lies with human resource directors across the state (there are more than one thousand) who simply did not perform their jobs.

INDY: Is this a result of fraud that you suspect?
Folwell: We are the largest purchaser of health care in North Carolina. Health plans that are a fraction of our size do enrollment audits every year or two. I got the State Health Plan about seven years ago. I pushed to get an audit done and, at that time, they found there were over seven thousand people on the State Health Plan [who were not eligible]. Our hope is that we find zero. Our expectation is that we’re going to find thousands of dependents—maybe even people who say they’re married but they’re not—on the State Health Plan receiving these benefits they’re not entitled to.

[Below is a copy of that audit.]

Secova-North Carolina DEVA - Project Analysis by K Fine on Scribd

The concern that we’re seeing is that this doesn’t seem overly secure in the age of identity theft.
We have a contractor that is in the business of doing enrollment audits. This is their expertise. In this digital world, we’re trying to make this as simple as we possibly can. But we have an obligation, when we have over eight hundred thousand people on the State Health Plan that is hemorrhaging money right now, we have an obligation to figure out if people are being truthful about who their dependents are and who they’re married to—especially as it relates to active employees, people who have misled the plan who still work for the state. I’ll be glad to do a deeper dive into [that security concern]. This should have been done already. When you went to work for North Carolina State or the Department of Transportation, the HR director is supposed to verify these dependents at that time. But people were not doing that.

Who’s performing the audit?
The people who are doing this for us are the same people who do our open enrollment. In many cases, they already have this information.

Are you saying that we have employees across the state who are supposed to be facilitating this plan who are not getting the documentation required to legitimize dependents as real people who deserve coverage?
Yeah. I’ve been on the State Health Plan for twelve or thirteen years and, for part of that time, I’ve had a wife and a son on the plan. I’ve never, ever been asked at any point to verify that they were my children or my wife. Ever.

That’s kind of insane, isn’t it?
Well, yeah. I’ll say on a positive note, I’ve talked to some HR directors, like the guy at [UNC-Greensboro] who is on top of this all the time.

Why did we wait a decade to determine we needed an additional audit?
Anytime it’s other people’s money, folks don’t worry about it like they should. I don’t have that choice. I’m the keeper of the public purse. And inside that purse is money from me and you and everybody. So I’m going to take this seriously.

Once you get this audit back, if it reveals what you suspect it will, will you, at that point, issue a directive that requires these HR directors to get these documents?
I’m always of the opinion that you don’t need a law to do what’s right and what’s wrong. I’ve already started this with Governor Cooper. We’re putting this message out loud and clear. I think there are administrative rules and statute that’s already in the books that give me the right to be more direct about this.

Let’s say you’ve got five thousand people who’ve been lying. What do you do at that point?
The bigger story is that we are literally paying money out of one side of this building to people who owe us on the other side of the building. We’re giving checks to pensioners who owe us from the State Health Plan. The bigger story is how in the hell does the twenty-sixth largest pool of money in the world in the state bank where you’ve got one hundred and seventy-five billion dollars … In this day in age, how can we be better about not sending money out of the second floor when people owe us money on the first floor?



In potentially related news, The News & Observer is reporting that Mona Moon, the day-to-day executive in charge of the health plan, abruptly resigned
. From the N&O:
Moon couldn’t be reached for an interview but issued the following statement via e-mail:

“Treasurer Folwell has a different vision and strategy for the State Health Plan than former Treasurer Janet Cowell, as is to be expected with any change in leadership. I spoke with Treasurer Folwell a few weeks ago about my role as executive administrator and suggested he might want to consider someone who shares his vision and approach. He believed I could be that person.

“He did not ask me to resign, and while the recent N&O article highlights a professional difference, I did not resign because of the article. I resigned because I still believe he should fill the role with someone who more closely shares his vision and management style.”

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