Review of Missouri Medicaid Payments for Services Provided to Deceased Recipients

EXECUTIVE SUMMARY:

The objective of this review was to determine whether the State paid claims for deceased Medicaid recipients during the period October 1, 1998 through December 31, 2001 and, if so, to determine the amount of the unallowable payments.  To accomplish our objective, we identified, using computer analysis, 75,193 claims representing 2,939 Medicaid recipients that were potentially paid after the date of death.  Subsequently, we selected a statistical sample of 200 from the 2,939 recipients for further review and determined, with the State's concurrence, that claims of $20,242 for 97 Medicaid recipients were unallowable.  Projected for the 2,939 recipients, we estimated that unallowable claims paid for services after death totaled $196,232 (Federal share $118,362).  However, the State indicated that not all claims were recoverable due to their age.  Our review also showed that unallowable payments were due, in part, because the State was maintaining incorrect or missing information in the Medicaid Management Information System (MMIS), the database used for monitoring payments made after the date of death.