Medicare Pays $23M in Dead Claims

Cheryl Clark, for HealthLeaders Media , November 4, 2013

A federal investigation finds that although CMS has safeguards to prevent and recover Medicare payments made on behalf of deceased beneficiaries, claims have slipped through and been paid.

Medicare reimbursed providers and suppliers $23 million for healthcare services to beneficiaries in 2011, despite the fact that those beneficiaries had died more than a month earlier, according to an Office of Inspector General's report issued Oct. 31.

The Centers for Medicare & Medicaid Services "has safeguards to prevent and recover Medicare payments made on behalf of deceased beneficiaries," the agency said. "However, it inappropriately paid $23 million [less than one-tenth of a percent of total Medicare expenditures] in 2011 after beneficiaries' deaths. Part C (Medicare Advantage plans) accounted for 86% of these improper payments," or $19,906.805 for 11,835 deceased beneficiaries.

Part A claims submitted for dates of service (hospital, home health, skilled nursing facility, and/or hospice care) after beneficiaries' dates of death totaled $1.634,280 for 193 deceased beneficiaries.

Claims under Part D, which covers prescription drugs, with dates after death amounted to $1,049.444 for 5,101 beneficiaries. And claims under Part B, for physician and non-physician fees, amounted to $592,823 for 1,541 beneficiaries who had died by their dates of service.

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