As we trudge through this mess that the ACA is creating I am reminded of another pseudo-insurance disaster run by the government.
Earlier this year I hired a part time adjuster that was laid off by Anthem when they outsourced the job to the Philippines. A normal adjuster should do 20 claims per hour. This adjuster averaged 1 claim per hour. Give her a couple warnings, no improvement. Catch her padding her time sheet, she does it two more times. Finally terminate her for lack of production and falsifying her time sheet.
And then it starts to get expensive. She files a claim saying she was let go for lack of work. Even though lying on an unemployment application is supposedly illegal, I don't think anyone has ever been taken to task for this. Then the paperwork starts; I have over an inch of filings with ODJFS (Ohio Department of Job and Family Services) of responses to their letters and copies of emails sent to the employee warning her.
Today I get a letter;
"... this agency finds that the claimant is totally unemployed from Employee Benefit Concepts Inc. due to a lack of work."
$1,440.92 of my money was just given to an ex employee fired for not working and padding her time sheet. Not to mention, right after firing her I hired a replacement, a sure-fire defense for any lack of work claims (you would think).
When I call ODJFS they now say the letter was an error and she was not awarded benefits for lack of work, she was awarded benefits because I didn't have her sign the emails warning her about her poor performance. This was a remote employee that lived 3-4 hours away that only came to the office once for training. When asked how remote employees are supposed to sign warnings, we were told that we should have required her to come in (like that would happen). Not to mention, I lost another case where an employee refused to drive 1 hour to the office.
Luckily Anthem is paying the majority of the claim and I am only out $1,440.92 plus a few thousand dollars of my time, but this is a great example of what goes wrong when insurance is misused by government for social causes.
Paying an ex-employee not to work is not an insurable interest, I'm forced to buy a policy that not only doesn't benefit me, it's actually counter to my interest.
ODJFS, who makes the benefit determinations, has no stake in the game. No matter how egregious the determination or riddled with errors, they have no accountability. They can give away employers' money regardless of how bogus the claim and counter to actual policies and they are doing a good thing, helping the poor unemployed.
Fraud is an acceptable part of the process. I have even called the fraud hotline to report ex-employees claiming they were let go for lack of work when clearly that was not the case and was told that is what applicants are instructed to do. Apparently the hours wasted of employers time has no value to ODJFS and fraudulent claims are just potential payments that need massaged.
Anthem found the right solution, outsource the jobs out of Ohio where you pay less, get more, and have no ODJFS giving away your money.