The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released a study evaluating policies and procedures on claims allegedly submitted for deceased individuals. The Centers for Medicare & Medicaid Services (CMS) maintains policies and procedures to ensure that Medicare does not pay for services purportedly furnished to beneficiaries following their dates of death. The policies primarily outline methods for identifying and recouping such improper payments. The OIG audited claims between calendar years (CYs) 2013 and 2015 with dates of service that followed dates of death.
The OIG reported the following findings:
- Existing policies and procedures generally ensured that CMS did not make payments when data systems showed that an individual had died before the claimed date of service;
- CMS failed to identify and recoup all improper payments for the 3.5 billion Medicare Parts A and B claims submitted during CYs 2013 to 2015;
- CMS paid roughly $426,000 in improper payments for 427 Medicare claims;
- CMS paid nearly $1.5 million in improper payments for 1,047 Medicare claims; and
- Improper and potentially improper payments accounted for 0.0002 percent of Part A and B payments made during CYs 2013 and 2015.
The OIG recommended that CMS:
- Direct contractors to recoup the amounts paid for claims for which dates of service followed dates of death;
- Confirm that the improper payments identified in the OIG study have been recouped; and
- Check the accuracy of beneficiary dates of death against conflicting date-of-death information to identify and recoup improper payments.
The OIG report is available at:
Department of Health and Human Services Office of Inspector General. “Medicare’s Policies and Procedures Identified Almost All Improper Claims Submitted for Deceased Individuals and Recouped Almost All Improper Payments Made for These Claims for January 2013 Through October 2015.” A-07-16-05089. 6 Oct. 2016.