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

EXECUTIVE SUMMARY:

The objective of our review was to determine whether Medicare fee-for-service claims paid in Maryland during the 3-year period of January 1, 1997 through December 31, 1999 were in compliance with Federal regulations and Centers for Medicare & Medicaid Services (CMS) guidelines.  The State of Maryland was one of 10 states selected for review.  We found 70 percent of our sample of 100 claims in Maryland were appropriate.  However, two claims totaling $2,328 were unallowable according to Medicare reimbursement requirements. The claims were submitted on behalf of beneficiaries who were inmates in local detention centers at the time of service. We have determined these claims to be unallowable because in the absence of third party coverage, neither the county detention centers nor their health care contractors make any attempt to collect health care costs from inmates.  We could not determine the allowability of 28 claims totaling $4,133.