Review of Medicare Payments for Services Provided to Incarcerated Beneficiaries in the State of Florida

October 30, 2002

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Medicare fee-for-service claims paid for services provided to incarcerated beneficiaries during the 3-year period January 1, 1997 through December 31, 1999 were in compliance with federal regulations and Centers for Medicare & Medicaid Services (CMS) guidelines.  This review is part of a nationwide review requested by the Senate Finance Committee.  We found that prisoner data from the Social Security Administration was not contained in CMS's records; therefore, the Medicare fiscal intermediary and carrier in Florida did not have controls in place to detect claims submitted on behalf of incarcerated beneficiaries.  Once CMS' common working file edit and modifier are initiated, corrective actions can be implemented.  We will provide CMS, for their referral to the State, with specific examples of instances in which due diligence was not pursued and corrective actions may be necessary.