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Federal Audit Reveals Poor Training Yields Disastrous Results For Medicare Beneficiaries
Monday, February 11, 2013 13:48
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By PPRN Staff
10 Feb 2013
Medicare Part D, also called the Medicare prescription drug benefit, is a federal program to subsidize the costs of prescription drug and is a part of the Medicare Modernization Act of 2003 (MMA) and went into effect on January 1, 2006. Subsidized premiums are paid to the prescription drug provider (PDP) or Medicare Advantage prescription drug plan (MA-PD) by the Center for Medicare and Medicaid Services (CMS) and are based on the service area’s regional benchmark premiums.
Certain beneficiaries are automatically deemed subsidy-eligible. These beneficiaries have Medicare Parts A or B, or both, and are:
Already entitled to Supplemental Security Income (SSI),
Eligible for full Medicaid coverage, or
Covered under one of the Medicare Savings Programs as a Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or Qualified Individual (QI).
Once this program was moved by Congress the Social Security Administration began training its employees at the Wilkes-Barre Data Operation Center (WBDOC) to processes the applications for the low income subsidy. This is the same Data Operations Center that endorses the abuse of break time for smoke breaks, and allows for the fraudulent filing of time sheets.
As new employees began their careers with the social security administration they were trained according to the latest policies and procedures.
The employees were charged with reviewing the application for completeness after the application was scanned and reviewed by the system that would detect logic errors.
In Fiscal Year 2011, which ran from October 1, 2010 to Sept 30, 2011 the Office Of Quality Performance, a division of the Social Security Administration conducted an audit of the benefit awards. Their findings represent gross inefficiencies, deplorable training, and the effects of reduced manpower in a top-heavy bureaucracy.
Of the 336 reviewed cases, WBDOC staff processed 333 exceptions and transferred 3 applications to the Field Office (FO) for resolution. WBDOC staff complied with Program Operations Manual System (POMS) when processing the award exceptions in 254 cases but did not comply with POMS in 82 cases.
Table 1: POMS Compliance Rate POMS
Reviewed Cases
Projected Population
Percent of Population
Compliant
254
19,673
76.9
Non-Compliant
82
5,911
23.1
TOTAL
336
25,584
Among the 82 cases where WBDOC staff did not comply with POMS Exception Processing procedure, we found 124 instances of non-compliance. WBDOC staff did not:
