- The Washington Times - Thursday, June 10, 2004

Maryland health officials failed to identify nearly $1 million in benefits that health care providers had billed for persons who were dead at the time the claims were submitted, according to a federal report.

“The state agency failed to identify these claims for deceased beneficiaries and, consequently, unallowable payments were made to providers,” said a report released Wednesday by the Inspector General’s Office of the U.S. Department of Health and Human Services.

Federal officials uncovered the improper payments, which occurred from 1998 to 2001, by examining 100 Medicaid claims and found that 15 of the payments were for services billed for patients after they had died.

Based on that survey sample, the report estimated $940,000 in improper payments during the three-year period, but did not identify the providers responsible for the overbilling.

According to the report, problems stemmed from the failure of state health officials to check monthly reports containing the names of deceased individuals against reports containing names of eligible Medicaid beneficiaries.

“Since more than 2 million people die in the United States each year, specific action to identify and delete these individuals from Medicaid files is required,” the report said.

The Inspector General’s Office is recommending that Maryland health officials identify and recover the overpayments, and that state officials “improve methods of data matching” to screen out improper payments.

Nelson J. Sabatini, secretary of the Maryland Department of Health and Mental Hygiene, said in a letter to the Inspector General’s Office that “the department has been persistent in identifying overpayments for deceased beneficiaries” in recent years.

Mr. Sabatini defended the performance of the health department under Gov. Robert L. Ehrlich Jr., saying yesterday that state officials had removed 20,000 ineligible recipients from Medicaid services in recent years.

“The last administration did not do a good job in maintaining the eligibility of the enrollment,” Mr. Sabatini said.

The federal audit found problems similar to those found last year by a city audit of a D.C. government-funded health plan called the D.C. Healthcare Alliance.

The audit by the D.C. Office of the Inspector General found that about 2,600 people had obtained health services in 2002 by using invalid Social Security numbers. Among the ineligible recipients, the report said, 40 had enrolled for health services using Social Security numbers of deceased people.



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