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March 31, 2025 - Harrisburg, PA

Performance Audit of UPMC's Community HealthChoices Contract Finds Reporting Delays Cost Taxpayers More Than $120,000 in 2022

On behalf of Auditor General Timothy L. DeFoor, Deputy Auditor General for Audits Gordon Denlinger today released the findings of a performance audit of UPMC's Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS) that found UPMC failed to update participant information, which cost taxpayers more than $350,000 in 2022-- $120,000 of which DHS was unable to recover.

"UPMC is required to report to DHS whether a person has died, went to jail or is no longer eligible to be part of the program," Denlinger said. "DHS uses this as part of the data to set the rate it pays UPMC to provide care to people on Community HealthChoices. UPMC needs to make sure there is greater accountability in its management structure to ensure the required assessments are happening on time and regularly."

Speaker list:
Deputy Auditor General for Audits Gordon Denlinger
Leigh Ann Weaver, Performance Audit Senior Manager



Gordon Denlinger, Deputy Auditor General for Audits, releases the findings from an audit of UPMC Health Plan regarding the Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS)...Community HealthChoices is a health insurance program, administered by DHS, that coordinates care for individuals to improve their health care experience -serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. UPMC coordinates care for these services across the Commonwealth.<br><a href="https://filesource.amperwave.net/commonwealthofpa/photo/27484_AudGen_UPMC_EmilyDamiano_01.jpg" target="_blank">⇣ Download Photo</a> Gordon Denlinger, Deputy Auditor General for Audits, releases the findings from an audit of UPMC Health Plan regarding the Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS)...Community HealthChoices is a health insurance program, administered by DHS, that coordinates care for individuals to improve their health care experience -serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. UPMC coordinates care for these services across the Commonwealth.<br><a href="https://filesource.amperwave.net/commonwealthofpa/photo/27484_AudGen_UPMC_EmilyDamiano_02.jpg" target="_blank">⇣ Download Photo</a> Gordon Denlinger, Deputy Auditor General for Audits, releases the findings from an audit of UPMC Health Plan regarding the Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS)...Community HealthChoices is a health insurance program, administered by DHS, that coordinates care for individuals to improve their health care experience -serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. UPMC coordinates care for these services across the Commonwealth.<br><a href="https://filesource.amperwave.net/commonwealthofpa/photo/27484_AudGen_UPMC_EmilyDamiano_03.jpg" target="_blank">⇣ Download Photo</a> Gordon Denlinger, Deputy Auditor General for Audits, releases the findings from an audit of UPMC Health Plan regarding the Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS)...Community HealthChoices is a health insurance program, administered by DHS, that coordinates care for individuals to improve their health care experience -serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. UPMC coordinates care for these services across the Commonwealth.<br><a href="https://filesource.amperwave.net/commonwealthofpa/photo/27484_AudGen_UPMC_EmilyDamiano_04.jpg" target="_blank">⇣ Download Photo</a> Gordon Denlinger, Deputy Auditor General for Audits, releases the findings from an audit of UPMC Health Plan regarding the Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS)...Community HealthChoices is a health insurance program, administered by DHS, that coordinates care for individuals to improve their health care experience -serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. UPMC coordinates care for these services across the Commonwealth.<br><a href="https://filesource.amperwave.net/commonwealthofpa/photo/27484_AudGen_UPMC_EmilyDamiano_05.jpg" target="_blank">⇣ Download Photo</a> Gordon Denlinger, Deputy Auditor General for Audits, releases the findings from an audit of UPMC Health Plan regarding the Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS)...Community HealthChoices is a health insurance program, administered by DHS, that coordinates care for individuals to improve their health care experience -serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. UPMC coordinates care for these services across the Commonwealth.<br><a href="https://filesource.amperwave.net/commonwealthofpa/photo/27484_AudGen_UPMC_EmilyDamiano_06.jpg" target="_blank">⇣ Download Photo</a> Gordon Denlinger, Deputy Auditor General for Audits, releases the findings from an audit of UPMC Health Plan regarding the Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS)...Community HealthChoices is a health insurance program, administered by DHS, that coordinates care for individuals to improve their health care experience -serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. UPMC coordinates care for these services across the Commonwealth.<br><a href="https://filesource.amperwave.net/commonwealthofpa/photo/27484_AudGen_UPMC_EmilyDamiano_07.jpg" target="_blank">⇣ Download Photo</a> Gordon Denlinger, Deputy Auditor General for Audits, releases the findings from an audit of UPMC Health Plan regarding the Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS)...Community HealthChoices is a health insurance program, administered by DHS, that coordinates care for individuals to improve their health care experience -serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. UPMC coordinates care for these services across the Commonwealth.<br><a href="https://filesource.amperwave.net/commonwealthofpa/photo/27484_AudGen_UPMC_EmilyDamiano_08.jpg" target="_blank">⇣ Download Photo</a> Gordon Denlinger, Deputy Auditor General for Audits, releases the findings from an audit of UPMC Health Plan regarding the Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS)...Community HealthChoices is a health insurance program, administered by DHS, that coordinates care for individuals to improve their health care experience -serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. UPMC coordinates care for these services across the Commonwealth.<br><a href="https://filesource.amperwave.net/commonwealthofpa/photo/27484_AudGen_UPMC_EmilyDamiano_09.jpg" target="_blank">⇣ Download Photo</a> Leigh-Ann Weaver, Auditor, joins Gordon Denlinger, Deputy Auditor General for Audits, to release the findings from an audit of UPMC Health Plan regarding the Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS)...Community HealthChoices is a health insurance program, administered by DHS, that coordinates care for individuals to improve their health care experience -serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. UPMC coordinates care for these services across the Commonwealth.<br><a href="https://filesource.amperwave.net/commonwealthofpa/photo/27484_AudGen_UPMC_EmilyDamiano_10.jpg" target="_blank">⇣ Download Photo</a> Leigh-Ann Weaver, Auditor, joins Gordon Denlinger, Deputy Auditor General for Audits, to release the findings from an audit of UPMC Health Plan regarding the Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS)...Community HealthChoices is a health insurance program, administered by DHS, that coordinates care for individuals to improve their health care experience -serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. UPMC coordinates care for these services across the Commonwealth.<br><a href="https://filesource.amperwave.net/commonwealthofpa/photo/27484_AudGen_UPMC_EmilyDamiano_11.jpg" target="_blank">⇣ Download Photo</a> Leigh-Ann Weaver, Auditor, joins Gordon Denlinger, Deputy Auditor General for Audits, to release the findings from an audit of UPMC Health Plan regarding the Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS)...Community HealthChoices is a health insurance program, administered by DHS, that coordinates care for individuals to improve their health care experience -serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. UPMC coordinates care for these services across the Commonwealth.<br><a href="https://filesource.amperwave.net/commonwealthofpa/photo/27484_AudGen_UPMC_EmilyDamiano_12.jpg" target="_blank">⇣ Download Photo</a> Leigh-Ann Weaver, Auditor, joins Gordon Denlinger, Deputy Auditor General for Audits, to release the findings from an audit of UPMC Health Plan regarding the Community HealthChoices contract with the Pennsylvania Department of Human Services (DHS)...Community HealthChoices is a health insurance program, administered by DHS, that coordinates care for individuals to improve their health care experience -serving more people in communities rather than in facilities, giving them the opportunity to work, spend more time with their families, and experience an overall better quality of life. UPMC coordinates care for these services across the Commonwealth.<br><a href="https://filesource.amperwave.net/commonwealthofpa/photo/27484_AudGen_UPMC_EmilyDamiano_13.jpg" target="_blank">⇣ Download Photo</a>