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Ohio Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries’ Deaths Audit

Ohio made capitation payments totaling $90.5 million on behalf of deceased beneficiaries. We confirmed that all beneficiaries associated with the 100 capitation payments in our stratified random sample were deceased. Ohio properly recovered 37 of these capitation payments. However, Ohio did not recover the remaining 63 capitation payments totaling $74,495 ($51,431 Federal share). On the basis of our sample results, we estimated that Ohio did not recover unallowable payments to Medicaid Managed Care Organizations totaling at least $51.3 million ($38 million Federal share) during our audit period.

Ohio did not always identify and process Medicaid beneficiaries’ death information. Although Ohio’s eligibility systems regularly interfaced with Federal data exchanges that identify dates of death, county caseworkers did not always receive notification that beneficiaries had died.

Filed under: Centers for Medicare and Medicaid Services