Snag in Computer System Trips Up Medicare Benefits
A coalition of advocacy groups are suing the Department of Health Services over a computer error that resulted in Medicare beneficiaries being sent bills inappropriately and denied services in some cases, MediaNews/San Jose Mercury News reports.
The Legal Aid Society of San Mateo County, the National Senior Citizens Law Center and the Western Center on Law and Poverty are bringing the suit, which seeks class action status on behalf of qualified Medicare beneficiaries in 18 California counties. The state pays Medicare premiums for this class of beneficiaries.
According to MediaNews/Mercury News, the suit is to be filed Tuesday in San Francisco Superior Court (Manekin, MediaNews/San Jose Mercury News, 2/27). However, the San Francisco Examiner reports that the suit was filed on Monday (Winegarner, San Francisco Examiner, 2/27).
The situation revolves around CalWIN, a computer system that 18 counties together purchased to help administer public assistance programs. Counties began rolling out the program in 2005 (MediaNews/San Jose Mercury News, 2/27).
Melissa Rodgers, directing attorney for the Legal Aid Society of San Mateo County, said, "The old system was set up to keep people on unless they were no longer eligible." She said CalWIN "was designed to cut people off unless [administrators] went in manually to prevent it, even if [beneficiaries] were continually eligible" (San Francisco Examiner, 2/27).
DHS became aware of the problem in 2006 when Medicare beneficiaries began receiving bills for premiums, according to Rodgers (MediaNews/San Jose Mercury News, 2/27).
DHS spokesperson Michael Bowman said that the agency has asked the counties to correct the error but that it remains unclear whether individual counties or DHS is responsible for making the change. The agency also has forwarded the names of affected beneficiaries to CMS so they could be reimbursed for any premiums they might have paid, Bowman said (San Francisco Examiner, 2/27).
A news release indicates that the lawsuit asks that DHS:
- Stop denying coverage to qualified beneficiaries;
- Reinstate coverage to people who were inappropriately dropped; and
- Reimburse beneficiaries for premiums or out-of-pocket costs they paid before the error was corrected (MediaNews/San Jose Mercury News, 2/27).