Medicare Pays $23M in Dead Claims
The report singled out the high number of claims for services after dates of death that Medicare did not pay, and noted that those providers and suppliers who submitted those claims may be involved in "fraud, waste, or abuse."
For example, in 2011, 46,903 providers and suppliers submitted claims for payment for services after beneficiaries died, and for which Medicare did not pay out. Of these, 190 providers and suppliers had more than 100 unpaid Part B claims with service dates after beneficiaries' dates of death; 75% (143) were suppliers. And of these providers and suppliers, the investigators wrote, "one-fourth (48 of 190) were located in New York City, Los Angeles, or Miami.)"
CMS responded that it is considering the development of a model that would identify providers who submit claims for services after their patients died and if viable, will launch it as part of the Fraud Prevention System next spring.
A 2008 OIG report detailed similar concerns, many of which CMS said it has remedied, and which prevented the agency from making millions more in improper payments.
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
- Providers Lag as Consumers Set Agenda
- ICD-10 Delay Alters Provider, Vendor Prep
- Esther Dyson Launches Population Health Challenge
- Crisis Spurs Healthcare Payment Reform in Arkansas
- Payment Reform Naysayers 'Better Wake Up'
- Look Beyond Nurse-Patient Ratios
- HIT Leaders Want Flexibility, Transparency from Next HHS Chief
- As Hospitalist Patient Loads Rise, So Do Hospital Costs
- Reduce Readmissions by Activating Patients to Do 'Self-Care'
- Advance Directives: Let's Make a Law