A recent audit made of policies and procedures followed by the Centers for Medicare and Medicaid Services, during the calendar years 2012 through 2015, revealed that $2.4 million in Medicare Parts A and B payments were made after the beneficiaries had died.
The audit was conducted by the Office of Inspector General for the U.S. Department of Health and Human Services, which stated, “We evaluated the policies and procedures that CMS had in place as of November 2015 to determine
whether they were effective in ensuring that these capitation payments to MA organizations for Parts A and B services were not made. We also evaluated the policies and procedures to determine whether they were effective in ensuring that improper payments were identified and recouped. ”
During the audited period, payments exceeded $616 billion. The audit noted that a total of $2.96 billion was recovered from Medicare Advantage (MA) organizations for Parts A and B capitation payments that had been made to beneficiaries who had already died. However, as of March 7, 2017, another $2.4 million in improper payments had not been recouped, paid out to 978 dead beneficiaries.
The auditors wrote, “We recommend that CMS recoup the $2.4 million in capitation payments made to MA organizations for Medicare Parts A and B services on behalf of deceased beneficiaries and implement system enhancements to identify, adjust, and recoup improper capitation payments in the future.”
Part A Medicare payments cover most medically necessary hospital, skilled nursing facility, home health and hospice care expenses.
Part B Medicare payments cover most medically necessary doctors’ services, including outpatient services, medical equipment, laboratory tests, x-rays, mental health care, and some home health and ambulance services.
“The Medicare Access and CHIP [Children’s Health Insurance Program] Reauthorization Act of 2015 (MACRA), signed into law in April 2015, requires the Centers for Medicare & Medicaid Services (CMS) to establish policies and implement claim edits to ensure that payments are not made for Medicare services ostensibly rendered to deceased individuals. These policies and procedures should include steps to prevent such improper payments from occurring, as well as steps to detect and recoup payments that have been made (including prior-year payments) for Medicare services rendered after the individuals’ dates of death,” the Inspector General auditors wrote.
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