Audit of Payments for Medicaid Services to Deceased Beneficiaries - October 1, 1998 Through September 30, 2001 - New York State Department of Health

October 20, 2004

EXECUTIVE SUMMARY:

The objective of this review was to determine the amount of Medicaid overpayments resulting from providers billing for medical services for dates after the beneficiaries' death.  We found that for the period October 1, 1998 through September 30, 2001, the New York State Department of Health did not identify all payments for medical services provided after death.  In a statistical sample of 100 paid claims, where the beneficiaries' death occurred within our audit period, we found 5 payments amounting to $401 for services billed to Medicaid beneficiaries after their deaths.  We also found 24 additional payments for which the beneficiary had multiple indications of death. Based on the projected results of our statistical sample, we estimate that $6.7 million in payments were made to beneficiaries with multiple indicators of death.  The lack of access to death certificates prevented us from making a conclusive determination of the amount of overpayments.  We recommended that the State agency determine whether the beneficiary died prior to the Medicaid provider's billed date of service and recover any overpayments,  expand data sharing between the State agency's and New York City's Medicaid and Vital Records Offices, and consider using the SSA death file to improve data matching and to enhance identification of Medicaid deceased beneficiaries.  New York officials generally agreed with the recommendations and initiated corrective actions.