Audit of Payments For Medicaid Services To Deceased Recipients, October 1, 1998 Through September 30,

EXECUTIVE SUMMARY OBJECTIVE The objective of our review was to determine the amount of Medicaid overpayments resulting from payments to providers for medical services provided after the recipients’ death. FINDING The Pennsylvania Department of Public Welfare (State agency) did not identify all of the payments to providers for medical services provided after the recipients’ death. In a statistical sample of 200 paid claims, we found 111 payments (55 percent), amounting to $19,154, that were for services provided to Medicaid recipients after their deaths. Based on the results of a statistical sample, we estimate that unrecovered, unallowable payments were approximately $1.5 million (Federal share $800,000). The State agency’s data matching procedures failed to identify these claims for deceased recipients and, consequently, unallowable payments were made to providers. We determined that death certificates for recipients associated with 96 unallowable payments were on file at the Pennsylvania Bureau of Vital Records and confirmed the deaths of two additional recipients through contacts of agencies in other States. Other data files supported the deaths of additional recipients associated with 13 unallowable payments. RECOMMENDATIONS We recommend that the State agency: • Recover non-managed care payments from the specifically identified overpayments of $19,154 (Federal share $10,314) for Medicaid services after the ...