Wednesday, November 9, 2011

Healthcare Fraud at Metro Under the Microscope

Unsuck DC Metro has learned that Metro, along with ATU 689, has hired an outside contractor to conduct a massive, first-time-ever audit of thousands of current and former Metro workers and their dependents in the hopes or rooting out what is believed to be alarming abuse of Metro healthcare, done largely by adding ineligible people to the plan.

"Although we believe the majority of our enrolled dependents meet our eligibility requirements, there may be some instances when a member mistakenly covers an ineligible dependent," reads the document that was sent to ATU 689 members.

One source we talked to said they knew an employee who openly boasted about having relatives on his plan who should not have been. Another employee, according to the source, said he had an ex-wife and her new family on the plan.

Apparently, and unsurprisingly, Metro has been very lax in updating dependent/spouse information.

One worker we talked to said that every year he gets a letter from the plan asking him if anything has changed in his family situation. The worker, who is divorced, said the year he got divorced he made sure his ex-wife was taken off the plan. But it was all done on an honor system, and he could have easily left her on the plan, and no one would have checked, he said.

"No one is cross checking with public records," they said.

Another source, recently retired from working at Metro headquarters, said:
It doesn't surprise me that HR never bothered to check paperwork on dependents for health insurance. But to give HR a break, the Local 689 healthcare was not administered very much by them, but by the union's own Health and Welfare Office who signed people up and then passed the bill on to Metro. In retrospect, it now occurs to me that the unions didn't have a reason to adequately police the rolls of the insured because some of their members would be getting something extra from big, mean and oh-so-profitable Metro.
Another source said it was commonly known that Health and Welfare office would turn a blind eye to questionable documents regarding dependents.

I called Secova, the outside entity conducting the audit, and was told "some bad apples have spoiled the pie; there were instances of employees claiming brothers and sisters as dependent children."

Two other Metro sources we talked to confirmed health insurance abuse is believed to be widespread.

"There's an ongoing joke around here that some employees will adopt every niece and nephew to load them onto the health insurance," wrote one Metro employee. His sentiments were echoed by another source.

However, one former union president believes the audit is a waste of time.

Mike Golash wrote the following in an email:
This has never been done before, mainly because it was felt to be unnecessary. When an employee is hired he has to document his dependents to get them on the plan. I am sure there are occasions when an employee fails to report a divorce in a timely way or the death of a child or spouse but I have never known of any cases of fraud.

Metro is trying to save money on the cost of health insurance. They feel the audit will do this. I am willing to bet that the cost of the audit will be greater than any money saved by it.

I received the letter. It told me I had to produce a marriage certificate and my 1040 form. I have been married 40 years and have no idea where my marriage certificate it, so it is somewhat of an inconvenience.
The recently retired source, who is very familiar with Metro's finances and auditing processes didn't think the audit would make any difference.
Don't expect much [to come from the audit]! If the problem is too big, it'll be swept under the rug for fear of antagonizing Local 689. My guess is that they'll make an example of a couple of mechanics to show some effort and then it will go back to business as usual, hoping that the public will be more interested in screwed-up elevators than in girlfriends' kids on the Metro health insurance dime.
Sounds like pretty much the way Metro handles everything.

(Here's a list of the contributions employees make the the various plans, along with Metro's contribution.)

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