Over $200 Million in Medicaid Payments Sent to the Deceased: A Growing Problem & What’s Being Done
Are your tax dollars being wasted on healthcare payments for people who are no longer alive? A recent report reveals a startling truth: Medicaid programs across the US improperly disbursed over $200 million to healthcare providers for deceased individuals between 2021 and 2022. This isn’t a new issue, but a persistent and escalating problem demanding immediate attention. This article dives deep into the causes, consequences, and potential solutions to this critical issue, providing a complete overview for concerned citizens, healthcare professionals, and policymakers alike.
The Scale of the problem: A Nation-Wide Audit Reveals Shocking Figures
The Department of Health and Human services’ (HHS) Office of Inspector General (OIG) released a report in late 2023 detailing over $207.5 million in improper managed care payments made on behalf of deceased enrollees between July 2021 and July 2022. This figure represents a nationwide snapshot, building upon previous audits conducted since 2016.Prior to this latest report,the OIG had already identified approximately $289 million in similar improper payments across 18 individual state Medicaid programs.
This isn’t simply an accounting error; it represents a significant drain on vital resources intended for living patients. The issue isn’t isolated to specific states, according to Aner Sanchez, Deputy Regional Inspector General in the Office of Audit Services, who has been researching this problem for over a decade. “This is not unique to one state, and the issue continues to be persistent,” Sanchez stated in an interview with the associated Press.
Why Are Payments Still Going to the Deceased? The Root Causes
Several factors contribute to these improper payments. The core issue lies in the lag between a person’s death and the update of beneficiary lists within Medicaid systems. This delay allows claims for services rendered after the date of death to be processed and paid.
Here’s a breakdown of the contributing factors:
* Data Matching Challenges: Medicaid agencies rely on accurate and timely death data. While the Social Security Administration (SSA) maintains the “Full Death Master File” (DMF) – a comprehensive database containing over 142 million records dating back to 1899 - access to this file has been historically restricted due to privacy concerns surrounding identity theft and fraud.
* Systemic Delays: Even when death data is received,integrating it into complex Medicaid systems can be slow and cumbersome. Outdated IT infrastructure and inefficient data processing contribute to these delays.
* Administrative Hurdles: The process of reconciling claims and recovering improper payments can be complex and time-consuming, requiring coordination between state Medicaid agencies, healthcare providers, and the federal government.
* Data Accuracy Issues within the DMF: Recent reports indicate the SSA has been making frequent and sometimes controversial updates to the DMF itself, including erroneously classifying living individuals as deceased, further complicating its reliability. (Source: https://www.ssa.gov/oig/analysis-and-recommendations/audit-reports/)
The “One Big Gorgeous Bill” and Future Solutions
Recognizing the severity of the problem, a provision within the recent tax and spending bill (often referred to as the “One Big Beautiful Bill”) aims to improve data matching and reduce improper payments.This legislation mandates that Medicaid agencies conduct quarterly audits of their provider and beneficiary lists against the Full death Master File, beginning in 2027.
This represents a significant step forward, but it’s not a silver bullet. The 2027 implementation date means several years of continued improper payments are likely. Moreover, the effectiveness of the audits will depend on the accuracy and accessibility of the DMF.
Recent Successes with DMF Access: A five-month pilot program in early 2023,granting the Treasury Department temporary access to the DMF,yielded positive results. The program successfully clawed back over $31 million in improperly disbursed federal payments. This demonstrates the potential for significant savings with broader and more consistent access to the DMF.
What Can Be done Now? Actionable Steps for Improvement
While the 2027 mandate is promising, proactive measures are needed now to mitigate the problem. Here are some actionable steps:
* Expand DMF Access: Advocate for legislation that expands access to the Full Death Master File for Medicaid agencies, while simultaneously strengthening safeguards to protect against identity theft.
* invest in Modernized IT Systems: States should prioritize investments in modernizing their Medicaid IT infrastructure to improve data processing speed and accuracy.
* Streamline Data Matching processes: Develop automated data matching processes that can quickly and efficiently identify discrepancies
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