Could audit of PA employees’ healthcare benefits eligibility save taxpayers oodles of cash?

22 April 2024- Legislation to confirm eligibility of health benefits received by dependents of state employees authored by Rep. Eric Nelson (R-Westmoreland) was unveiled recently in Pennsylvania.

The proposal would require the Commonwealth to conduct an initial dependent eligibility audit of the group health insurance plans for state employees. Earlier this year, the federal government acknowledged health insurance enrollment scams may be costing Washington as much as $3 billion each year, Nelson told other Harrisburg lawmakers in a memo seeking their support for his legislation. 

“One news article told the story of a repair worker in Alabama who kept an ex-wife covered with health benefits for 14 years, and only got caught when he tried to add his new wife,” said Nelson. “As stewards and custodians of taxpayer dollars, we are obligated to investigate and address the very real possibility that this is also happening in state government.”

According to a report from the U.S. Government Accountability Office, until 2021, federal government offices were not required to verify family member eligibility, which left the program vulnerable to fraud and improper payments associated with ineligible family members. Nelson’s bill would require the Commonwealth to conduct an initial dependent eligibility audit of group health insurance plans for two state departments. Results of the audit would then be provided to the General Assembly.

“We have to start by seeing if Pennsylvania is experiencing the same issues as Washington, D.C., and then be ready to take action,” Nelson said. “Harrisburg isn’t spending toy money. Taxpayers should have full confidence that their investment in government is being used efficiently.”