MeriTalk report claims 11 percent of people who receive government healthcare benefits are not actually eligible.
A new report shows $342 billion in taxpayer money is wasted each year in improper healthcare payments due to challenges in verifying benefit eligibility.
According to the "The Economics of Eligibility" report, released on August 17, 11 percent of people who receive government healthcare benefits are not actually eligible. Case workers estimate 89 percent of their agency's current beneficiaries list is correct.
More than one in 10 beneficiaries are misdiagnosed, according to the report by MeriTalk, a public-private partnership focused on government IT, working with the U.S. General Services Administration.
MeriTalk surveyed 155 healthcare IT executives and program managers working with healthcare and other social service benefits.
Managers stated their number one challenge is data integration, with 85 percent reporting challenges to eligibility and verification of healthcare beneficiaries. The data show managers hamstrung by IT difficulties and short staffing during a time when healthcare enrollment rates are increasing the workload.
Sixty-three percent of case workers say enrollment rates for healthcare assistance and/or benefits have increased at their agency in the last two years. They estimate it takes agencies more than three weeks to confirm benefit eligibility for a new recipient, according to the report.
Forty-seven percent said a focus on data integration could cut significant financial loss and improve customer service; and 43 percent said their current processes hinder their agency's ability to satisfy beneficiary needs.
Managers cited three ways to improve: by hiring more staff, improving data integration across agencies and improving system automation.
A fully integrated IT system would lessen the need for extra staffing by improving productivity by 23 percent, according to the report.
Forty-four percent of IT pros said they are not able to leverage all available data due to system and/or integration challenges.
The report summarizes that agencies should build on progress through hiring, improve data integration and automation, and enhance training programs.