by Nicholas Ballasy
The OIG found that despite prior audits and corrective actions, some of the same issues persist, such as states continuing to make capitation payments to MCOs for enrollees who have passed away.
A new report from the Office of Inspector General within the Department of Health and Human Services shows multiple states made improper Medicaid payments to managed care organizations after enrollees had died, which exposes persistent fiscal and oversight problems in the nation’s Medicaid managed-care system.
In addition, Secretary of Agriculture Brooke Rollins said late last week that SNAP benefit payments have been going to deceased people as well.
The audit, titled “Multiple States Made Medicaid Capitation Payments to Managed Care Organizations After Enrollees’ Deaths,” summarizes findings from 14 prior state-level audits from July 1, 2009, through December 31, 2019.
In those earlier reports, the OIG found that states made an estimated $248.6 million in unallowable "capitation payments" to MCOs on behalf of deceased enrollees.
(A capitation payment is a way of paying healthcare providers or organizations in which they receive a "predictable, upfront, set amount of money to cover the predicted cost of all or some of the health care services for a specific patient over a certain period of time," according to the Centers for Medicare and Medicaid Services.)
The federal share amounted to about $171.8 million. At the time of the report, roughly $41 million of the federal share remained uncollected from the states in question.
The OIG found that despite prior audits and corrective actions, some of the same issues persist, such as states continuing to make capitation payments to MCOs for enrollees who have passed away.
Mistakes that lead to erroneous payments:
The OIG uncovered a series of mistakes that led to the payments going to dead people, including:
- Eleven of the audited states failed to always identify and process death information for Medicaid enrollees in a timely manner.
- Four states did not use eligibility systems that interface directly with federal or state death-data exchanges, "requiring agency officials to conduct manual matches between the data systems"
- Nine states failed to enter dates of death into their Medicaid enrollment systems even though those dates were available through data exchanges.
- Some states have under-utilized alternative data sources (e.g., obituary data, third-party identity information services) that might help identify deceased recipients.
- Six states lacked sufficient internal controls to ensure deceased enrollees were identified during regular reviews.
What the OIG recommends
OIG said the Centers for Medicare & Medicaid Services “could do more to help states that continue to make improper capitation payments to MCOs on behalf of deceased enrollees.”
OIG recommended 3 main steps, including:
- Collect the outstanding unallowable payments from states totaling an estimated $41 million in federal funds
- Ensure that states complete actions on remaining recommendations designed to strengthen their internal controls and eligibility-verification processes.
- Use data-matching tools to monitor risk, specifically to match the Transformed Medicaid Statistical Information System (T-MSIS) enrollment data against the Social Security Administration’s Death Master File (DMF) in order to identify states at higher risk of improper payments, and then provide those states with the results to "help reduce Medicaid capitation payments made to MCOs on behalf of deceased enrollees."
CMS response and next steps
CMS responded to the report, asserting that most of the prior audit recommendations, about 83%, have been implemented to prevent the payments from going to dead people. CMS noted that approximately $126 million of the federal share had already been refunded.
CMS did not formally concur with one of the key OIG recommendations – the routine matching of T-MSIS with the DMF – citing concerns about redundancy, inefficiency, timeliness of the T-MSIS data, and confusion for states.
In response, the OIG reaffirmed the validity of its recommendations and emphasized the need for targeted data-matching to help bolster oversight.
The audit comes amid ongoing scrutiny of Medicaid’s payment integrity. Effective eligibility and death-data verification matching processes are essential to ensure that dollars are paid only for living enrollees, according to the OIG.
Supplemental Nutrition Assistance Program issues
As for SNAP, Rollins said on the Fox News Channel that the Trump administration has uncovered significant problems with the program and it plans to announce changes soon.
“What we have found is staggering, half a million people getting benefits, two times under the same name, 5,000 dead people, 80% of able-bodied Americans, meaning they can work. They don't have small children at home. They're not taking care of an elderly parent. They can work, and they choose not to work, of course, because they're getting significant benefits from the taxpayer,” she said.
Rollins described SNAP as “perhaps one of the most corrupt, dysfunctional programs in American history.”
“We are cracking down. We now have a plan to fix it and we're really, really excited about doing that for the American people,” she said.
Rollins said on Friday that SNAP recipients will have to reapply for benefits.
Nicholas Ballasy
Source: https://justthenews.com/government/federal-agencies/dead-people-have-been-paid-hundreds-millions-medicaid-and-snap-report
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