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City Employees, Retirees Caught Abusing Health Care Plan

A consulting firm audited the 863 Evanston employees and retirees enrolled in the city’s health care plan and found that 17 people had listed a total of 23 nonqualified dependents.

 

A consulting firm hired by the city of Evanston recently found that there were 14 employees and three retired employees abusing the city’s health care plan by listing nonqualified dependents, including grandchildren and ex-spouses, according to city staff.

Gallagher Benefit Services audited the 863 city staff and retirees enrolled in the health care plan to look for ineligible dependents earlier this year, according to Marty Lyons, assistant city manager and chief financial officer. The audit cost just under $20,000, Lyons said, and is expected to save the city nearly $100,000 per year.

"We think it was a very successful program and we will have a much more accountable health plan because of it," he said.

Lyons said the city conducted the audit at the suggestion of consultants from Gallagher, who told city officials they could expect to find roughly three percent of health care plan members listing ineligible dependents, translating to a cost savings of three percent of the city’s annual health care budget. The actual number of people listing ineligible dependents turned out to be approximately 2.3 percent of the total number of city staff and retirees enrolled in the plan, according to Lyons. 

City officials began the process by offering employees and retirees an amnesty period, during which they could come forward to offer documentation for dependents without penalty. Among the city’s 715 enrolled health care members, some 75 people had not turned in their documentation, according to Lyons, and one person came forward during the amnesty period.

Once the amnesty period was over, Gallagher spent two months checking records before identifying 23 ineligible dependents who were drawing benefits from the city’s health care plan, according to Lyons.

Those dependents had been covered by the city for as long as 11 years, and for as little as three months, Lyons said. They included ex-spouses, foster children and grandchildren, often with the same last name as the covered employee.

“The lack of red flags, if you will, is one way people slip through,” Lyons said. “If somebody gets divorced and they don’t tell us they got divorced, we don’t know.” 

One employee had listed her grandchildren for the past seven years, according to Lyons. He said that employees had not always been required to submit birth certificates to the city’s human resources department as proof that someone was an eligible dependent, although they are now. 

In at least two cases, employees told auditors that the city’s previous human resources division manager had told them they could list dependents who were actually ineligible. The city had no records of such a conversation, so those two employees were not disciplined, Lyons said. 

The city’s previous human resources division manager, Judith Witt, retired in 2007, according to city documents. She was replaced by Cheryl Chukwu.

The findings of the city’s audit came up at Monday night’s council meeting, when Evanston resident Junad Rizki spoke about the issue during the portion of the meeting devoted to public comment. Rizki said he found out about the audit when city staff members discussed cost savings projected for the fiscal year 2013 budget during a public meeting held earlier this fall.

“What is troubling to me is we still have thieves on staff who are basically handling our tax dollars,” he said. “This casts a shadow of doubt over every city employee, including elected officials, who for years have taken medical benefits.”

But Lyons said that none of the city’s elected officials — including aldermen, the mayor and the city clerk — had listed unqualified dependents. As for the list of people who had violated the plan, Lyons said in an e-mail that "the city is not releasing employee names."

According to Lyons, seven of the people who were caught listing nonqualified dependents were disciplined. City officials kicked one retired employee off the health care plan entirely after they found out that he had been listing his ex-spouse as a dependent. 

“They actually admitted that they knew what they were doing,” Lyons said. 

To prevent similar problems in the future, he said the city will likely do more audits every few years and will tighten up its controls on documentation when members enroll dependents. 

I think our employees have received a very clear message,” he said.  

Editor's Note: A previous version of this story contained incorrect information about a a hypothetical ineligible dependent. We sincerely regret the error.

Related Topics: city health care, health care plan, ineligible dependents, and nonqualified dependents

shirley kohler

7:20 pm on Tuesday, November 27, 2012

are the employees who stole benefits being charged with insurance fraud and are they being required to pay back the benefits they stole?

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Millie

8:57 am on Wednesday, November 28, 2012

they will be told to stop and get a pay raise

Procrustes' Foil

4:45 am on Wednesday, November 28, 2012

This is insurance fraud. And it happens in all employment sectors. Legal action should be taken against these people in the public and private sectors.

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Dileep Gangolli

6:45 am on Wednesday, November 28, 2012

Good thing they work for the government. In the private sector they would be fired.

Just raise our taxes to pay for this.

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IMHO

7:58 am on Wednesday, November 28, 2012

The real crime is that a person in this country has to lie, cheat, and steal in order to get life-saving health care for a child. If I were in that situation I would do the same thing for my loved ones.

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michael

9:59 am on Wednesday, November 28, 2012

Then you are a crook too!!!!!!!!!!!

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Dan Z

10:53 am on Wednesday, November 28, 2012

John, you must not be very smart. At this point, all we know is that insurance fraud has been committed by a government employee. We know nothing about their economic circumstances or the economic circumstances of their family. Nevertheless, you jump to the extreme and unjustified conclusion that the people committing fraud are justified in doing so. So, in your twisted mind, any time you hear that someone steals public funds, but the details of the perpetrator's background are not released, you think the perpetrator did something admirable? Pretty weak thinking. You should put your dumb political talking points to the side and actually think things through once in a while.

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IMHO

12:33 pm on Wednesday, November 28, 2012

Okay, I am not a crook(!!!!!!!!!!!!!), consider myself smart enough, really don't have a twisted mind (although a few friends may disagree), and don't think I'm jumping to an extreme conclusion. And I did not say I admire what this person did. I just know that I would do anything to save the life of my child. If that's what you consider to be "weak thinking" then I am guilty. It's unfortunate that the lack of affordable health care in this country forces people to make these kind of choices. I don't think these are "dumb political talking points", but rather real, human, heart-breaking issues that many people are facing. You may now resume your insults and name-calling.

JT

8:15 am on Wednesday, November 28, 2012

I understand how some people cut corners to get health benefits, but this is insurance fraud and theft. As someone else said, in the private sector, if anyone did this, they would be terminated and possibly prosecuted; certainly, they should have to repay the system.

With all of the under- and unemployed eligible workers out there, it seems a little unfair that known perpetrators of fraud would still keep their jobs and benefits. Sorry if this sounds bitter, but...

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Millie

8:58 am on Wednesday, November 28, 2012

Are these employees that a friend or relatives of someone else on payroll

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Dan Z

10:57 am on Wednesday, November 28, 2012

There should be an outcry about such an extreme abuse of the public trust. These thieves should be fired and prosecuted like they would in the private sector. However, because this is a government body where rules everyone else plays by seemingly don't apply, expect very little to be done to the thieves.

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Debirag

11:34 am on Wednesday, November 28, 2012

I agree with all those above who insist these perpetrators be brought to justice! And, I want them off the city payroll now!

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Millie

12:57 pm on Wednesday, November 28, 2012

THIS HAS BEEN GOING ON FOR AT LEAST 11 YEARS. AND WERE ARE KEEPING THESE PEOPLE ON PAYROLL. WHAT A JOKE

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KJL

1:45 pm on Wednesday, November 28, 2012

This is not unusual. I used to work in for a benefits consulting firm and we often audited our client plans and found this kind of fraud. I am glad they are now asking for documentation. You would be surprised - many HR departments do not ask for documenetation (i.e., birth certificates, marriage certificates) and it is common for employees to conveniently forget to tell you that they are divorced if they still want to cover an ex-spouse. There are ways that you can cross-check this. I am surprised that a city of this size has never done an eligibility audit...

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KJL

2:15 pm on Wednesday, November 28, 2012

Another comment - the article mentioned that the employees were disciplined. I hope that there was an attempt to recover the erroneous claims and that legal counsel is involved...

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John C Thomson

3:36 pm on Wednesday, November 28, 2012

I am surprised they even allowed this to be aired in the news. Whoever that person was who did so, they will be the one who is fired. Evanston likes to keep their indiscrestions private, like Wilmette and Winnetka.

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annie

7:28 pm on Wednesday, November 28, 2012

The City of Evanston didn't need to pay $20k for an outside audit. The Human Resources Division could have done the audit themselves, and come up with the same results.
Eligibility should be checked every year, and birth certificates, marriage certificates are part of the process.

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Junad Rizki ( Ponzi)

10:20 pm on Wednesday, November 28, 2012

Jennifer - thank you for researching the story, as you know at Council after I spoke Wally ( city Manager ) claimed that this was not for the public, to know since it was a human resource matter and protect information, as you recall he claimed only a few employees were involved, what I hear was 22 dependents and the cost saving were several hundred thousand dollars. What everyone should understand, the major issue here is the taxpayers have been footing this bill, for years it well may be over 1 million in thief.

By the way, as I stated since you have not fired the employees, stating public officials were not involved is meanless. For years here public officials, abuse the system they were paying $35 a month up to about a year ago for full family coverage on a Blue Cross Blue sheild PPO plan, costing us over $17,000 per official, I have complained about it for years, when the last city manager left she raised the rate on them to what employees pay.

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Junad Rizki ( Ponzi)

10:28 pm on Wednesday, November 28, 2012

One other point - I asked at the budget hearing if they were paying the city back, staff claimed yes, but at the council I also asked to see in the city budget the line item showing what they paid back, since we are talking over $100,000 for one year alone each of these people would have had to pay back over $5,000. I do not believe we are going to be paid back?

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