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Report (OEI-03-12-00600)

01-23-2014
Over Four Million Medicare Summary Notices Mailed to Beneficiaries Were Not Delivered in 2012

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Summary

WHY WE DID THIS STUDY

As part of its efforts to reduce Medicare fraud and abuse, CMS relies on beneficiaries to report suspicious activity identified on their Medicare Summary Notices (MSNs). MSNs are paper forms that summarize processed claims. Claims processors are responsible for providing MSNs to beneficiaries. If MSNs go undelivered, beneficiaries do not have the opportunity to review the services or items billed to Medicare. The Department of Health and Human Services' FY 2011 Agency Financial Report identified CMS's lack of a policy for addressing undelivered MSNs as a weakness in the agency's financial oversight of Medicare contractors. This study provides information on the quantity of undelivered MSNs and the procedures that claims processors use to handle undelivered MSNs.

HOW WE DID THIS STUDY

We requested from CMS any policies regarding undelivered MSNs. For claims processors in operation during 2012, we reviewed their written procedures and survey responses regarding tracking and followup procedures for undelivered MSNs. From claims processors' survey responses, we determined the number of undelivered MSNs returned in 2012. In addition, we reviewed a purposive sample of 1,445 undelivered MSNs returned to 3 claims processing companies during the second full week of January 2013. For each undelivered MSN in our sample, we reviewed beneficiary addresses; identified compromised-e.g., stolen or misused-beneficiary and provider numbers; and calculated total Medicare-allowed amounts.

WHAT WE FOUND

Claims processors reported 4.2 million MSNs as undeliverable to beneficiaries. Without CMS guidance on undelivered MSNs, claims processors' tracking and followup procedures are limited and varied. Claims processors identified incorrect or invalid beneficiary addresses as the most common reason why MSNs were undeliverable. We found that there continues to be a problem with incorrectly populated beneficiary addresses in the data systems that claims processors use to process MSNs. Some of the undelivered MSNs reviewed were associated with compromised beneficiary or provider identification numbers.

WHAT WE RECOMMEND

Undelivered MSNs that are returned to claims processors cannot be reviewed by beneficiaries as a defense against fraud. Therefore, CMS should reduce the likelihood that MSNs are undeliverable by ensuring that the address information that claims processors use to print addresses on MSNs is complete and properly formatted. To help promote consistency and efficiency in activities related to undelivered MSNs, CMS should provide guidance to claims processors about whether and how to track and follow up on undelivered MSNs. CMS concurred with our recommendations.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

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