A state audit found that UPMC’s failure to report patient information cost taxpayers more than $120,000 in 2022.
Per Deputy Auditor General for Audits Gordon Denlinger, this finding comes after an audit into UPMC’s Community HealthChoices contract with the Pennsylvania Department of Human Services.
He explains that UPMC is required to report to the DHS when someone dies, goes to jail or is no longer eligible for the program. That information helps DHS set the rate it pays to UMPC to provide care to people on Community HealthChoices.
However, the audit found that UPMC failed to notify DHS of changes to participants’ program eligibility status and didn’t consistently provide Community HealthChoices participant eligibility information. As a result, DHS overplayed UPMC by $357,048 in 2022, with $120,977 of that money being unrecoverable.
“UPMC either didn’t perform the required assessments to see if people were still eligible for care, or when they performed the assessments, they were done too late,” Denlinger said.
The Auditor General’s Office found that UPMC needs to report changes to participants’ status weekly, which is what’s required.
We reached out to UPMC about the audit but have not yet heard back.
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