November 4, 2013 – Medicare fraud continues to be a growing problem, especially when the program reimburses providers for services rendered after a beneficiary has died. An OIG Report (OEI-4-12-00130) released on October 31, 2013, confirms that over $23 million Medicare dollars were wasted in 2011 on medical services billed for the deceased, after their dates of death.
Medicare only pays for services that are reasonable and medically necessary. As the report makes clear: “[m]edically necessary services cannot occur after a beneficiary’s death.” To obtain information regarding a beneficiary’s death, the Centers for Medicare and Medicaid Services (CMS) rely on information contained in its Enrollment Database. The Social Security Administration (SSA) and the Railroad Retirement Board (RRB) are CMS’s primary sources of information regarding dates of death which are recorded in the database.
Oftentimes, providers, such as nursing homes report deaths to SSA and RRB, and do so falsely, according to the Report. 251 Medicare providers and suppliers were identified by the OIG as having “high numbers of claims made to Part B with reported service dates after a beneficiary’s death.” In addition, 11 percent of the improper payments identified in the sample examined by OIG contained missing or incorrect dates of death.
The OIG Report also identified that 86% of the false claims for services were made to Medicare Part C. Medicare Part C, also known as Medicare Advantage, offers optional insurance coverage provided by private insurance companies (i.e. HMOs and preferred provider organizations). In 2011, 23% or $123.7 billion of overall Medicare expenditures were attributable to Part C. For beneficiaries enrolled in Parts C and/or D, CMS makes a payment to the particular Medicare Advantage organization to which each beneficiary subscribes on his or her behalf on a monthly basis.
CMS concurred with the remedial measures suggested by the OIG which included taking action against suppliers and providers that have high numbers of claims for services rendered after a beneficiary has passed, suggesting they might be false.
In 2011, LK whistleblower attorney Alan J. Konigsberg represented a nursing home worker who filed a lawsuit under the New York State False Claims Act alleging that the facility was billing Medicaid for beneficiaries who had passed away. The case resulted in a $745,000 recovery and a reward for the relator.