Tighter policy in place to prevent fake claims
The NMI Retirement Fund has implemented a stricter measure to prevent possible recurrence of fraudulent health claims following the controversial Megaplus International CNMI, Inc. case in 1999.
Group Health and Life Insurance Program manager Dolores Moore ordered all government health insurance subscribers to submit pertinent requirements when applying for a reimbursement.
In a memorandum, Ms. Moore instructed program subscribers and GHLIP personnel to consistently check submitted claims and bills filed by their clients in efforts to prevent cases of mishandled payments of medical bills.
The GHLIP also released the copy of the new reimbursement forms which will be accompanied by necessary health and medical records and bills when an applicant submits an application for claims.
The health insurance manager said failure of the claimants to comply with the policy will further delay the processing of their application since rounds of evaluation will be done to ensure the veracity of the applications.
The measure took effect early January before the Office of Public Auditor release the result of the audit and evaluation report on the Megaplus incident.
Public Auditor Mike S. Sablan recommended that the GHLIB should adopt a stricter measure to improve the internal control of the agency over the processing and payment of health insurance claims.
His recommendation include the submission of supporting claim documents which will be scrutinized and marked paid to prevent duplicate payments and the proper segregation of duties, signed checks for distribution to vendors and written filing procedures which will control and monitor the locations of accounting records and claim documents.
In addition to this, Mr. Sablan also endorsed the hiring of utilization review board and issuance of written operating procedures for processing of medical claims which will be drafted to address the inadequacies of existing practices.
The OPA recently released the result of its investigation on the Megaplus case revealing more than $800,000-worth of fraudulent claims paid by the GHLIB.
The report further disclosed claims were supported by falsified doctors’ prescription or referral forms and padded health insurance claims by billing unperformed and unnecessary treatments.
Megaplus is a local company providing physical therapy services to patients enrolled under the Group Health Insurance Plans which is being administered by the GHLIP.
