Transcript for audio podcast: Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011
From the Office of Inspector General of Department of Health and Human Services
[Jaime Durley] I'm Jaime Durley, Deputy Regional Inspector General for the Office of Evaluation and Inspections speaking with Rachel Bessette, a program analyst, about a report called "Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011." Rachel, sounds like an interesting topic. Could you tell us how this study came about?
[Rachel Bessette] Sure. Billing Medicare for services after a beneficiary died is not new. Previous OIG reports and audits identified inappropriate Medicare payments made on behalf of deceased beneficiaries. We've also seen healthcare fraud schemes involving providers or suppliers fraudulently billing for deceased beneficiaries.
[Jaime Durley] Is there anything being done to address this issue?
[Rachel Bessette] Yes, there is. In response to some of our previous work, the agency that oversees Medicare, the Centers for Medicare & Medicaid Services, or CMS, implemented safeguards to prevent and recover payments made on behalf of deceased beneficiaries.
[Jaime Durley] What are these safeguards?
[Rachel Bessette] Well, the safeguards vary depending on the part of Medicare in which the beneficiary is enrolled. If the beneficiary is enrolled in Part A or B, or traditional fee-for-service Medicare, CMS has a process that will go back and recover payments made on behalf of deceased beneficiaries. This process also is intended to prevent future improper payments.
[Jaime Durley] Are there other safeguards?
[Rachel Bessette] There are. For beneficiaries enrolled in Part C, also known as Medicare Advantage, or Part D, which provides prescription drug coverage, CMS automatically removes deceased beneficiaries from its systems and recovers any payments that were made after beneficiaries' dates of death.
[Jaime Durley] So, are these safeguards working?
[Rachel Bessette] Well, that's one of the reasons we did this report - to determine if any Medicare payments were made on behalf of deceased beneficiaries in 2011. We also looked at the accuracy of CMS's information on beneficiaries' dates-of-death.
[Jaime Durley] So what exactly did you find?
[Rachel Bessette] We found that CMS's safeguards to prevent and recover Medicare payments made on behalf of deceased beneficiaries appear to be largely effective. But they weren't perfect: Medicare did still inappropriately pay $23 million after beneficiaries' deaths in 2011. However, to provide some context, these improper payments represent less than one-tenth of a percent of total Medicare expenditures that year.
[Jaime Durley] Were these improper payments the result of inaccurate CMS date-of-death information?
[Rachel Bessette] Actually, no. CMS's date-of-death information was generally accurate. In fact, only 11 percent of the improper payments we identified, or about two and a half million dollars, were because of missing or incorrect dates of death in CMS systems. We do not know what caused the remaining improper payments.
[Jaime Durley] Did you find anything else?
[Rachel Bessette] Our evaluation also identified approximately 250 providers and suppliers that had a high number of Part B claims for services occurring after the beneficiary's death. One supplier, for example, had over 2,000 unpaid claims in 2011 alone. Even though these claims were not actually paid by Medicare, submitting a large number of claims for deceased beneficiaries may indicate potential fraud.
[Jaime Durley] Interesting. So, what did OIG ultimately recommend based on these findings?
[Rachel Bessette] We recommended four things to CMS. First, improve safeguards to prevent future improper Medicare payments after beneficiaries' deaths. Second, correct inaccurate dates of death in their systems and take action on the improper payments we identified. Third, monitor Part B claims with dates of service after the beneficiary's' death. Finally, take appropriate action to address the providers and suppliers with high numbers of Part B claims with service dates after beneficiaries' deaths.
[Jaime Durley] What was CMS's response to our report?
[Rachel Bessette] CMS agreed with all four of these recommendations.
[Jaime Durley] Rachel Bessette, a program analyst for the Office of Evaluation and Inspections, thank you so much for sharing this important work.
[Rachel Bessette] Thank you.
Let's start by choosing a topic
Priority recommendations summarized.
FY 2017 Work Plan
OIG projects planned for 2017.
Significant OIG activities in 6-month increments.