Audit of Payments for Medicaid Services to Deceased Beneficiaries, October 1, 1998 Through September 30, 2001, Massachusetts Office of Medicaid

EXECUTIVE SUMMARY:

The objective of the 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 Massachusetts Office of Medicaid did not identify all payments for medical services provided after death.  In a statistical sample of 100 paid claims, we found 52 payments were for services billed for dates after the Medicaid beneficiaries' deaths.  The overpayments were not adjusted.  As a result, we estimate that unrecovered overpayments were $1,007,431 (Federal share $503,715).  We recommended that the State agency review current methods of data matching to ensure deceased Medicaid beneficiaries are identified and overpayments are adjusted.  Massachusetts officials generally agreed with the recommendations and had initiated corrective actions.