OIG report finds claims filed on behalf of the dead

With Halloween just around the corner the HHS’ Office of the Inspector General just released a report showing that during a two-year period The Centers for Medicare & Medicaid (CMS) paid out nearly half a million dollars for claims made on dead people.

Federal law requires CMS to establish policies and implement claim edits to ensure that payments are not made for Medicare services ostensibly rendered to deceased individuals. However, in its most recent report, the watchdog agency identified $426,000 in “improper payments for 427 Medicare claims” between 2013 and 2015 related to claims for the deceased. It identified another $1.48 million in potentially improper payments for 1,047 Medicare claims with dates of service that were after the individuals’ dates of death.

These “zombie claims†if you will, are nothing new. In 2013, the OIG found that Medicare had paid out $23 million in benefits in 2011, for 17,403 people who were dead. In 2014, the OIG issued another report that found CMS had paid nearly $300,000 for HIV drugs for dead people.

OIG has conducted a number of studies over the years dedicated to learning how these payments are slipping through the system.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) signed into law in April 2015, required CMS to set up policies and implement claim edits to ensure that payments are not made for Medicare services rendered after a claimants’ death.

CMS relies on date-of-death information in its Enrollment Database (EDB) and its Common Working File (CWF) to identify improper and potentially improper Medicare payments for claims for services, medical equipment, and supplies with dates of service after individuals’ dates of death.

With regard to the latest report, CMS agreed that 332 claims totaling $415,069 were improper and that another 95 claims with payments totaling $11,450, while also improper, were recovered. As for the other 1,047 claims with payments totaling $1.48 million, CMS argued the payments were allowable based on the date-of-death information it had on file, but that the EDB had conflicting date-of-death information.

The OIG recommended CMS do the following:

• Direct Medicare contractors to initiate recoupment for $415,069 in improper payments associated with the 332 claims whose dates of service were after the individuals’ dates of death.

• Confirm that the $11,450 in improper payments associated with the 95 claims that were identified have been recouped.

• Review the accuracy of the beneficiary dates of death in the CWF and EDB to determine whether any of the $1,480,913 relating to the 1,047 claims with conflicting date-of-death information were improper payments, and if so, direct Medicare contractors to initiate recoupment for the identified amounts.

Healthcare providers would be well-advised to watch the dates of service on their claims to ensure they are not filed after the death of a patient. The watchdog agency’s efforts are designed not only to root out claims mistakenly submitted after the death of a patient, but also to detect outright fraudulent claims.

If you have any questions or concerns, feel free to contact The Health Law Offices of Anthony C. Vitale at 305-358-4500 or email us at info@vitalehealthlaw.com.