Medicare Paid Claims for Inmates, Undocumented Residents, Reports Find
Medicare paid more than $120 million from 2009 to 2011 for claims from inmates and undocumented residents, violating federal law, according to a pair of reports by HHS' Office of Inspector General, Politico reports.
Details of Reports
According to the reports, nearly 3,000 undocumented residents filed thousands of claims resulting in $91.6 million in Medicare payments. In addition, 11,600 inmates submitted more than 75,000 claims resulting in $33.6 million in Medicare payments.
Although CMS already has a system to flag charges for inmates and undocumented residents, the reports recommended that federal officials establish a better system. The reports found that the current system does not flag payments until after they are paid and that CMS does not instruct its contractors to recoup such payments (Cheney, Politico, 1/24).
Acting CMS Administrator Marilyn Tavenner in a statement said that some of the payments could have been legitimate. She said the federal government covers the medical care of some inmates in states that make prisoners pay for care, which likely includes some of the inmates who received the Medicare payments.
Tavenner also said some of the payments to undocumented residents might have been proper because some individuals had their legal status "retroactively updated" (Carlson, Modern Healthcare, 1/24).
However, CMS officials said the agency in April is launching a new system to help recoup improper payments for Medicare claims by inmates and undocumented residents (Kennedy, AP/Atlanta Journal-Constitution, 1/24).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.