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 New York to identify potential payments for alleged services after death. This match resulted in $35.8 million of potential overpayments for alleged services 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 New York Department of Health (State agency) did not identify all of the payments billed for medical services on dates after a beneficiary’s death. From the developed universe of potential overpayments, we statistically selected 100 payments and confirmed that 5 were for alleged services after the Medicaid beneficiary’s death and 24 were for alleged service dates after the SSA’s recorded date of death. The beneficiaries had multiple indicators of death. As a result, we estimate that $6.7 million in potential overpayments were ...