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OIG: Dead beneficiaries don't need Medicaid
OIG has a recommendation for health care providers: Don't
bill government programs for services to beneficiaries who have died.
State auditors in Ohio in partnership with OIG found that
$82 million in Medicaid reimbursements were paid to providers for services
to deceased beneficiaries from Jan. 1, 1994 to Sept. 30, 1999, says a
recent audit report (A-05-00-00045). The State of Ohio's Office of the
Auditor compared paid claims from Medicaid files to state vital statistics
files via computer, and found that over a period of nearly six years,
114,780 payments were made to 4,113 different providers for services to
26,822 apparently deceased recipients. More than 30% of the overpayments in question continued
for at least six months after the recipients' dates of death, and about
10% of the overpayments continued after a year-and-a-half or more, the
May 17 report states. The average time to discover and recover such overpayments
was a little more than five months after the recipients' date of death.
In spite of state efforts to recover outstanding overpayments,
as of Sept. 30, 1999, $14.2 million remained unrecovered, of which about
$8.5 million is federal. Of these unrecovered payments, 75% was owed by
nursing homes. Officials do not yet know if these losses are criminal
in nature or just mistakes. "At this stage, there's no way of knowing
if providers are intentionally committing fraud or unintentionally slipping
up," said Johnnie Butts, Jr., chief of fraud, waste and abuse prevention
of Ohio's Office of the Auditor. "Audits of individual providers
have not been conducted yet. We believe at this time, however, that the
percentage of potential fraud is fairly small." There are currently no penalties in Ohio for not reporting a recipient's death to the state Medicaid agency in a timely manner, but state auditors have recommended the establishment of sanctions against delinquent providers. Other recommendations include asking county human services departments to report deaths correctly and linking state Medicaid databases with state vital statistic databases for periodic updates. ©2000 UCG. |