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Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011

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Rachel Bessette

Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011

Rachel Bessette, a program analyst for the Office of Evaluation and Inspections in Atlanta, is interviewed by Jaime Durley, Deputy Regional Inspector General for the Office of Evaluation and Inspections.

WHY WE DID THIS STUDY

Prior OIG studies and audit reports have identified Medicare payments made on behalf of deceased beneficiaries. CMS implemented safeguards to address this vulnerability. Health care fraud schemes have involved providers or suppliers submitting fraudulent claims to Medicare, including claims for deceased beneficiaries.

HOW WE DID THIS STUDY

We identified Medicare beneficiaries who, according to the Social Security Administration, died from 2009 to 2011. We then identified Medicare Part A and B claims and Part C and D payments from 2011 associated with these deceased beneficiaries. We also analyzed paid and unpaid Part B claims with service dates after beneficiaries' deaths to identify providers and suppliers associated with high numbers of these claims.

WHAT WE FOUND

CMS has safeguards to prevent and recover Medicare payments made on behalf of deceased beneficiaries; however, it inappropriately paid $23 million (less than one tenth of a percent of total Medicare expenditures) in 2011 after beneficiaries' deaths. Part C accounted for 86 percent of these improper payments. Additionally, 11 percent of these improper payments resulted from missing or incorrect dates of death. Further, we identified 251 providers and suppliers that had high numbers of paid and/or unpaid Part B claims with service dates after beneficiaries' deaths.

WHAT WE RECOMMEND

We recommend that CMS (1) improve existing safeguards to prevent future improper Medicare payments after beneficiaries' deaths, (2) take appropriate action on improper Medicare payments made on behalf of deceased beneficiaries and correct inaccurate dates of death, (3) monitor both paid and unpaid Part B claims with service dates after beneficiaries' deaths, and (4) take appropriate action on providers and suppliers that had high numbers of paid and/or unpaid Part B claims with service dates after beneficiaries' deaths. CMS concurred with all four recommendations.