KINGSTON – An audit of Ulster County’s health benefit plan found the self-funded plan had undetected and unpaid reimbursements owed to the county possibly as high as $188,000.
The report conducted by Comptroller Elliott Auerbach’s Office found that the plan had weak internal controls; gaps in communication between the broker, third party administrator and stop-loss carrier; a poor claims review process; and a lack of effective oversight.
The health plan has over 1,200 participants who pay “premium equivalents” and can choose from several options for individual and family coverage.
The county retains a broker, contracts with a third-party administrator and purchases stop-loss insurance to guard against catastrophic claims.
The actual costs in 2016, excluding dental, vision and Medicare retiree
coverage, were over $24.1 million, or $521,660 more than estimated.
Ulster County Personnel Director Sheree Cross responded to the audit
report.
“The County Comptroller fails to understand the complexities involved
in Health Insurance Administration and the incorrect assumptions used
by his office results in an inaccurate audit report. Specifically, the
unpaid reimbursements he identifies are not new and have been part of
the on-going claims adjudication process. Further, it is inaccurate to
suggest that there were no controls within this highly State-regulated
industry, and in fact it is unrealistic for an employer to position itself
within the normal adjudication process, indeed, it is the express reason
why Ulster County uses a third-party administrator,” she said.
