OIG: 14 states paid managed care organizations $249M for deceased Medicaid enrollees

Fourteen states gave managed care organizations payments for Medicaid enrollees for months after beneficiaries had died, a series of HHS Office of Inspector General audits found. 

In a report published Nov. 24, the OIG said the 14 audits uncovered an estimated $249 million in improper capitation payments for deceased enrollees. The audits were conducted for periods from 2009 to 2019. 

The payment errors occurred for multiple reasons, according to the OIG's report. Eleven of the 14 states did not always identify and process enrollees' death information, and several did not interface with federal data sources that identify individuals' dates of death. 

The following states were found to have unallowable payments for deceased enrollees: California, Ohio, Michigan, Florida, New York, Kansas, Illinois, Minnesota, North Carolina, Tennessee, Georgia, Texas, Indiana and Wisconsin. 

All but three states have repaid the federal government's share of the improper payments, according to the OIG's report. 

The OIG recommended CMS collect the remaining payments still owed to the government and explore opportunities to better link federal and state data to identify enrollee deaths. 

CMS disagreed with this recommendation. The agency said in its response to the OIG that adding such a system could prove redundant, burdensome and confusing. 

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