Report Materials
The Michigan Department of Community Health (DCH) claimed Federal Medicaid reimbursement for some Medicare Part B premiums it paid on behalf of beneficiaries who were ineligible for the buy-in program. Participating State Medicaid agencies are allowed to pay the monthly Medicare Part B premiums for certain Medicaid beneficiaries who are entitled to both Medicare and Medicaid benefits. The premium payments are made in cooperation with the Centers for Medicare & Medicaid Services (CMS) under what is known as the "buy-in program." A State may claim Medicaid reimbursement for the Federal share of the Medicare Part B premiums it paid for eligibly enrolled individuals.
Of the 100 beneficiaries we randomly selected for review, 85 were eligible for enrollment in the buy-in program, and the Medicare Part B premiums that DCH paid on their behalf were allowable. The remaining 15 beneficiaries were ineligible for the buy-in program, and the Medicare Part B premiums that DCH paid on their behalf were unallowable. On the basis of our sample results, we estimated that DCH improperly claimed at least $517,000 (Federal share) in Medicare Part B premiums it paid for individuals ineligible for enrollment in the buy-in program for the quarters ended December 31, 2008, through March 31, 2010. In addition, for the quarters ended December 31, 2007, through September 30, 2008, DCH claimed $232.8 million ($139.5 million Federal share) for Part B premiums it paid on behalf of beneficiaries it could not readily identify nor document as eligible for the buy-in program.
We recommended that DCH (1) refund $517,000 (Federal share) to the Federal Government for improper Part B premiums claimed; (2) strengthen coordination efforts with DHS, CMS, and Social Security Administration officials to ensure appropriate corrective action is taken in verifying changes reported in a beneficiary's eligibility status; and (3) work with CMS to determine the allowability of the $139.5 million (Federal share) in Part B premiums claimed for Medicaid reimbursement for which DCH had inadequate support and refund any unallowable amount claimed. DCH disagreed with our findings and recommendations.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.