The University of California last summer found that 5 percent of dependents
shouldn't be on their employees' plans. Removing them saved the system $35
million.
The UC system didn't offer amnesty, said spokeswoman Shelly Meron, and it didn't
impose penalties on any employees with ineligible dependents on the rolls.
Recouping months or years of premiums paid by employers for ineligible
dependents can be a difficult exercise, said Frost, the Aon Hewitt's eligibility
expert.
"We see very few employers do that, less than 5 percent," Frost said. "It's just
a very messy process to look retroactively and figure out the point at which
someone should never have been covered."
And proving fraud can be a high bar to clear, said Dennis Jay, executive
director of the Washington, D.C.-based Coalition Against Insurance Fraud.
"Most systems give the benefit of the doubt," Jay said. "For example, if someone
gets divorced and keeps the ex-spouse on the plan when they shouldn't have,
that's pretty innocent stuff."
CalPERS spokeswoman Rosanna Westmoreland cited a law that makes it a crime to
improperly obtain a benefit -- including health insurance -- by making a false
statement. Anyone convicted of that misdemeanor may be liable for paying
reparations.
"So, if CalPERS discovers fraud as part of the audit, it will refer these
matters to the appropriate district attorney for prosecution," Westmoreland
said, and the system will seek restitution as part of sentencing.
Since launching the amnesty period last month, CalPERS subscribers have
voluntarily removed 1,650 ineligible dependents. Of those, 1,220 were on state
plans. School district employees and other public agency workers dropped a
combined 430.
Their insurance costs averaged $4,400 per person per year -- twice the sum
CalPERS originally estimated -- and equals $7 million in savings.
There's no doubt that many more ineligible dependents will turn up during the
verification process, Frost said.
"The people abusing the system will think, 'I'll just keep my dependent covered
for a while and wait until they catch up with me,' " Frost said. "The rest will
honestly think, 'I'm not doing anything wrong, so I'll just ignore it.' "
Once the amnesty period ends next month, New York-based HMS Solutions will begin
verifying dependent eligibility using documents such as joint tax returns or
birth certificates that CalPERS will require subscribers to submit.
CalPERS has never audited its insurance rolls, so it had no history to lean on
when it estimated roughly 4 percent of enrolled dependents aren't qualified for
benefits. It used the experience of other public agencies such as the University
of California and Alabama's state retirement system.
But the percentage can run much higher. In 2008, Milliman Inc. conducted an
audit for an 8,000-employee firm. About 6,000 had dependents on the company
health plan, employee benefits specialist Penny Plante wrote in a company
article, and nearly 18 percent of them were ineligible.
Aon Hewitt "has seen results on the low end of 3 percent dropped and on the high
end 30 percent dropped," Frost said. "In the vast majority of cases, people just
don't understand the rules."
___
(c)2013 The Sacramento Bee (Sacramento, Calif.)
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