The inspector general has reported to the Department of Health and Human Services, an estimated 26.2 million in Medicaid payouts by the state of Florida to managed care organizations on behalf of dead beneficiaries over the past 5 years.
A package of benefits is provided to Medicaid recipients by the managed care organizations. The organizations have contracts with the state that give them a set monthly payment for each medicaid enrollee in exchange for services.
From July 1, 2009 to November 5, 2014 an audit uncovered that Florida had 114 contracts with 37 managed care organizations.
The inspector general found that during this time the state had continued making payments to these organizations even after the beneficiaries had died.
The state had paid $192.273 on behalf of the dead beneficiaries, according to a random sampling of 124 payments by the inspector general.
In the reports, it mentions that “These overpayments occurred because the State agency did not timely update the DODs [date of deaths] in the Florida Medicaid Management Information System, and the beneficiaries’ enrollments were not updated once they were identified as deceased.”
Furthermore, the state did not “collaborate with other state and federal agencies to determine the inconsistency between the sources of DODs or use additional sources or alternative procedures to determine the reason its data sources were inconsistent.”
Auditors estimate the state overpaid by $26,202,536 on behalf of the dead beneficiaries, based on the 124 payments sampled. They have recommended that over payments should be recovered by the state and procedures set in place to make sure death information is updated and accurate.
Mallory McManus, the Florida Agency for Health Care Administration communications director, said that “The agency has already recouped almost $24 million of the $26 million in overpayments. In managed care, capitation payments are made for the upcoming month to ensure continuity of care and to prevent lapses in health care coverage.”
H/T Free Beacon
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