Audit of Payments For Medicaid Services To Deceased Recipients, October 1, 1998 Through September 30, 2001 - Pennsylvania Department of Public Welfare

EXECUTIVE SUMMARY:

The objective of this review was to determine the amount of Medicaid overpayments resulting from payments to providers for medical services provided after the recipients' death.  We found that for the period October 1, 1998 through September 30, 2001, the Pennsylvania Department of Public Welfare did not identify all payments for medical services provided after death.  In a statistical sample of 200 paid claims, we found 111 payments (55 percent), amounting to $19,154, that were for services provided to Medicaid recipients after their deaths.  Based on the results of the statistical sample, we estimate that unallowable payments of approximately $1.5 million (Federal share $800,000) were not recovered.  Although the State agency agreed that deficiencies existed in the identification of deceased recipients and recovery of overpayments during the audit period, they do not agree to identify and refund additional overpayments.  They believe there would be limited success in identifying the overpayments and that the current enhancements have eliminated the reported problems.  We believe the review for additional fee-for-service overpayments is justified and should be performed by the State agency.