In a shocking revelation, new findings from the Department of Health and Human Services indicate that Medicaid programs made over $200 million in improper payments to healthcare providers for beneficiaries who were deceased between 2021 and 2022. This report emphasizes that such issues are widespread and not confined to a single state, as noted by Aner Sanchez, deputy regional inspector general for the Office of Audit Services.
The report disclosed that from July 2021 to July 2022, improper managed care payments totaled over $207.5 million for deceased individuals. Sanchez has stressed the importance of improving payment procedures and believes legislative measures, such as the new auditing requirements in the recent bipartisan spending bill, will aid in addressing these financial discrepancies.
There are expectations that requiring states to audit Medicaid beneficiary lists quarterly against the Full Death Master File database— which contains 142 million records dating back to 1899— could prevent similar improper payments in the future. The recommend sharing of information from this file could enhance accuracy, although its use has historically been restricted due to privacy concerns.
The findings come as part of an ongoing series of audits that the Inspector General's office has conducted since 2016, highlighting a significant issue that has persisted over time as states often make payments for deceased enrollees, impacting the overall Medicaid system.
Earlier this year, the Treasury Department managed to recoup over $31 million in such payments, showcasing the potential effectiveness of auditing following strategic access to the Full Death Master File. However, complications have arisen, including unusual revisions to the file that affect its reliability for ongoing audits, presenting further challenges in safeguarding against erroneous payments.
The report disclosed that from July 2021 to July 2022, improper managed care payments totaled over $207.5 million for deceased individuals. Sanchez has stressed the importance of improving payment procedures and believes legislative measures, such as the new auditing requirements in the recent bipartisan spending bill, will aid in addressing these financial discrepancies.
There are expectations that requiring states to audit Medicaid beneficiary lists quarterly against the Full Death Master File database— which contains 142 million records dating back to 1899— could prevent similar improper payments in the future. The recommend sharing of information from this file could enhance accuracy, although its use has historically been restricted due to privacy concerns.
The findings come as part of an ongoing series of audits that the Inspector General's office has conducted since 2016, highlighting a significant issue that has persisted over time as states often make payments for deceased enrollees, impacting the overall Medicaid system.
Earlier this year, the Treasury Department managed to recoup over $31 million in such payments, showcasing the potential effectiveness of auditing following strategic access to the Full Death Master File. However, complications have arisen, including unusual revisions to the file that affect its reliability for ongoing audits, presenting further challenges in safeguarding against erroneous payments.
