By Nicole C. Brambila | Denver Gazette
Thousands of deceased Coloradans stayed on the state’s Medicaid rolls, as the state continued paying managed care organizations to cover them, a lapse federal investigators flagged as wasteful in a recent audit.
Colorado made an estimated $7.3 million in capitation payments between 2018 and 2020, according to the U.S. Department of Health and Human Services Office of Inspector General (OIG). The payments continued for some Coloradans months after their deaths because of outdated reporting and system delays, state officials said.
Simply stated, capitation payments are fixed monthly fees paid to managed care organizations for each Medicaid enrollee.
“We know that there is fraud, waste, and abuse in the system that we have to be able to find so that we can actually save Medicaid for the vulnerable populations who need it most,” U.S. Rep. Gabe Evans, a Commerce City Republican, said in a statement to The Denver Gazette.
Released in February, the Colorado audit is one in a series examining the fees states paid on behalf of deceased enrollees to managed care organizations, often large networks, that administer Medicaid coverage under contract with the state.