Review of Medicare Payments for Incarcerated Beneficiaries in the State of Ohio

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Medicare fee-for-service claims paid in Ohio during the 3-year period of January 1, 1997 through December 31, 1999 were in compliance with federal regulations and Centers for Medicare and Medicaid Services guidelines.  Ohio was 1 of 10 States selected for review.   We reviewed a randomly selected statistical sample of 100 claims.  We found that all 100 sample claims were appropriate.  The sample included 92 claims for beneficiaries in psychiatric hospitals operated by the Ohio Department of Mental Health.  We determined that these beneficiaries did qualify for Medicare coverage because under State law, the beneficiaries were responsible for repayment of medical costs and the State did pursue collection.  The final eight claims in our sample were also allowable because the beneficiaries were not incarcerated on the day of the medical service.