Audit of Selected States' Medicaid Payments for Services Claimed To Have Been Provided to Deceased

DEPARTMENT OF HEALTH & HZTMAN SERVICES Office of Inspector General Washington, D.C. 20201 SEP 2 6 2006 TO: Mark B. McClellan, M.D., Ph.D. Administrator FROM: Audit of Selected States' Medicaid Payments for Services Claimed To Have SUBJECT: Been Provided to Deceased Beneficiaries (A-05-05-00030) The attached final report summarizesthe results of ow audits of 10 States' Medicaid payments for services claimed to have been provided to deceased beneficiaries. Federal regulations (42 CFR 5 433.304) state that an overpayment is the amount paid by a State Medicaid agency to a provider in excess of the allowable amount for furnished services. Because medically necessary services cannot be provided after a beneficiary's death, no medical services are allowable after a beneficiary's death. Accordingly, payments for medical services claimed to have been provided after a Medicaid beneficiary's death are overpayments. Our objectives were to (1) consolidatethe results of the 10 State audits of unrecovered overpayments for medical services claimed to have been provided to deceased Medicaid beneficiaries and (2) determine why the States did not identify and recover the overpayments. In 8 of the 10 States audited, providers received an estimated total of $27.3 million ($15.1 million Federal share) in Medicaid overpayments, which the States never recovered, for services claimed to have been provided after beneficiaries' deaths. All 10 States had procedures and some ...