Audit of Payments for Medicaid Services to Deceased Beneficiaries, October 1, 1998 Through September

EXECUTIVE SUMMARY BACKGROUND The Social Security Administration (SSA) maintains a data file of deceased individuals, to assist in preventing payments for services after death. The data file is compiled from death certificate information purchased from state governments and from death notifications received from funeral homes, friends, and family. The SSA maintains the most complete death records for the Federal Government. The data file is available to State and Federal Government entities. We matched this file against Medicaid payments by the State of Massachusetts to identify potential payments for services billed for dates after death. OBJECTIVE The objective of our review was to identify Medicaid overpayments resulting from provider billings for medical services for dates after the beneficiaries’ death. FINDINGS The Massachusetts Office of Medicaid (State agency) did not identify and adjust all payments to providers for medical services billed for dates after the beneficiaries’ death. From the developed universe of potentially unallowable payments, we statistically selected 100 payments. We confirmed that 52 payments were for services billed for dates after the Medicaid beneficiaries’ deaths. The overpayments were not adjusted. As a result, we estimate that unrecovered overpayments were $1,007,431 (Federal share $503,715). Payments were made for services for dates after the beneficiaries’ death, even though death ...