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Audit (A-01-09-00519)

Review of Medicare Parts A and B Services Billed With Dates of Service After Beneficiaries' Deaths

Executive Summary

Based on our sample results, we estimated that CMS did not identify and recover $8.2 million in overpayments for Medicare Part B claims with dates of service after the beneficiaries' deaths. Federal regulations state that Medicare will not pay for any expenses incurred for items or services that are not reasonable and necessary. Because medically necessary services cannot be provided after a beneficiary dies, payments for claims with dates of service after a beneficiary's death are overpayments. CMS did not make or had already recovered overpayments for Medicare claims on behalf of 96 of the 150 beneficiaries in our sample, including all of the Part A claims sampled. However, CMS did not identify and recover all overpayments for Part B (durable medical equipment and physician/supplier) claims with dates of service after the 54 remaining sampled beneficiaries' deaths.

We recommended that CMS (1) recoup $15,000 in overpayments identified in our sample, (2) use our Part B data to identify and collect potential overpayments estimated at $8.2 million for the nonsampled beneficiaries, (3) provide program safeguard contractors with complete date-of-death information, (4) correct the Common Working File (CWF) process to ensure that dates of death from home health claims are entered in the CWF, (5) work with the Social Security Administration to obtain verified dates of death to assist in identifying overpayments, and (6) establish a CWF edit to check all prior claims for a deceased beneficiary for overpayments once a date of death is added to the CWF. CMS concurred with our recommendations.

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