Dependents stand to lose health care 26 percent of workers at state hospital fail to document relatives

Unions angered by survey

Effort to find fraud is called invasion of employees' privacy

March 17, 1997|By Peter Jensen | Peter Jensen,SUN STAFF

The first stage of a controversial three-year campaign requiring all state employees to prove their health care beneficiaries are who they claim has uncovered some potentially serious problems at one state facility.

The government survey found that 26 percent, or 73 of 278 eligible workers at Clifton T. Perkins Hospital Center, a facility in Jessup that houses the criminally insane, were unable or unwilling to provide evidence -- typically birth certificates or marriage licenses -- to prove their dependents are eligible for health care benefits.

As a consequence, 102 people -- the number of dependents claimed by the workers -- are scheduled to lose their health insurance coverage next month.

The survey's results have raised questions about the possible extent of health insurance fraud, waste and abuse in state government. But they have also baffled researchers conducting the pilot project because they found far fewer discrepancies in another bureaucracy of similar size, the Maryland Department of Agriculture.

"I can't account for the difference," said T. Eloise Foster, deputy secretary of the Department of Management and Budget, which is overseeing the survey. "It may be premature to judge what's going on."

Were the Perkins employees deliberately trying to claim benefits for friends or extended family or was it simple oversight or perhaps even a matter of laziness? The answer may have implications for the state's 70,000 workers.

That's because all state employees will ultimately be required to produce documentation of dependents under the three-year program mandated by the General Assembly. The agency-by-agency screening is aimed not at uncovering fraud but at reducing health insurance costs by more closely scrutinizing eligibility.

The Agriculture Department is the only other state agency to complete the survey under the first-year pilot program. If its results are more typical than Perkins,' the savings are likely to be minuscule. Of that agency's 290 eligible workers, seven failed to provide documentation of seven dependents.

And even eliminating those seven probably won't save much money. Five were "oversights" -- mostly adult children who probably weren't filing claims anyway -- and the two others simply lacked the necessary papers, said Catherine E. Glover, a personnel officer in the Agriculture Department. "We may end up with zero benefits [to state government] when it's said and done," Glover said. "I didn't find any fraud."

Unions representing state employees are angered by the survey, which they believe is insulting to the workers.

Union officials said demanding such documentation implies dishonesty and constitutes an invasion of privacy.

"You don't know what information an employee considers private. Maybe it's the father of their child," said Janet Anderson, a spokeswoman for the Maryland Classified Employees Association. "Unless there's a reason to suspect a problem, the employee's information should be considered correct."

Gary J. Frank, an organizer with American Federation of State, County and Municipal Employees Local 92, said the Perkins results probably point to the difficulty of rounding up documents rather than fraud.

Take the case of a grandmother caring for grandchildren, he said. She must not only provide a birth certificate, but have tax returns or court documents to back up a guardianship that may not be formally sanctioned.

"Unless this is handled properly, people may be dropped from the insurance rolls who have a right to be there," Frank said. "You can't just send a notice and believe people have received and understood it."

Officials concede that no Perkins employees have admitted fraud. They point out that the majority of the 73 in question simply did not respond to written notices.

Dr. M. Richard Fragala, superintendent of the state hospital, said the fact that the maximum-security facility operates around the clock has made it far more challenging to communicate with employees than is typical in state agencies.

"That doesn't mean people are derelict," he said. "It's just difficult for us by routine notification to get these people on line."

Foster said workers will be sent final notices at their home addresses before their dependents are dropped. She said she has heard few complaints about the survey from state workers, who also stand to benefit if insurance costs are kept down.

"The object is not to be punitive," she said. "I'm hoping Perkins is an abnormality."

The survey sprang from a 1995 legislative audit of the state's employee and retiree health care benefits program. The report cited a survey in Chicago that found 10 percent of city employee dependents were ineligible for health care benefits and recommended Maryland examine its situation.

As a result, the legislature's fiscal committees directed the budget department to survey all state agencies.

Health care industry officials said such an effort to document dependents is not a common practice. Insurers often monitor the ages of an employee's children to keep track of when they become adults and lose eligibility.

"We haven't heard of many employers doing this," said Stephanie L. Poe of A. Foster Higgins & Co., a national benefits consulting firm. "It's probably not a trend."

Pub Date: 3/17/97

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