Watchdog: Follow the Money

Medicare paid $23 million for services after beneficiaries' deaths

Watchdog,Watchdog Blog,Medicare and Medicaid,Entitlements,Inspectors General,Waste and Fraud,Follow the Money,Ethan Barton

Medicare inappropriately paid $23 million for services that began after the death of more than 17,000 beneficiaries in 2011, according to the Department of Health and Human Services’ inspector general.

The payments were made to providers, suppliers, and others on behalf of Medicare beneficiaries who died after 2009, 2010, or 2011.

“Medically necessary services cannot occur after a beneficiary’s death,” the report said. “Therefore, payments for services provided after a beneficiary’s deaths are inappropriate.”

Medicare initially paid $610 million for two specific Medicare plans, but successfully recovered 97 percent of these payments.

While the majority of these beneficiaries had less than $1,000 in improper posthumous payments, 10 had more than $50,000 each, and two accounted for more than $250,000.

Of the total, $20 million was paid to 514 organizations. One organization received $1.1 million of the inappropriate payments.

One reason for the improper payments was that Medicare’s database in 2011 had missing or incorrect dates of death. The missing dates accounted for $2.5 million of the inappropriate payments.

The $23 million accounted for less than one-tenth of a percent of the total Medicare expenditures in 2011, but shows vulnerability in safeguards the program had implemented to prevent such fraud, according to the IG.

Medicare will take measures to address this vulnerability and will take action to recover the inappropriate payments, the report said.

This is not the first instance of such improper payments. In 1997, the IG found Medicare similarly paid $20.6 million for services that began after beneficiaries’ deaths.

Medicare also paid nearly $29 million in prescription drug benefits on behalf of 4,139 illegal immigrants between 2009 and 2011, according to a separate IG report also released Thursday.

Medicare Part D pays prescription drug costs for those enrolled in parts A and B. The Centers for Medicare and Medicaid Services, which administers the program, has no policy on payments to illegal immigrants for Part D, and therefore no internal controls to detect and reject the improper claims, according to the IG. CMS does have a policy on part A and B payments, which identifies and automatically rejects claims on behalf of illegal immigrants.

CMS agreed to implement a policy on drug payments for illegal immigrants and recover improper payments made between 2009 and 2011.

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