CMS was "generally effective" in making sure that Medicare capitation payments were not made on behalf of deceased beneficiaries, identifying and recouping nearly $3 billion in such payments made between 2012 and 2015, according to a federal audit, John Commins writes for HealthLeadersMedia.
Audit findings
The audit, from HHS' Office of the Inspector General (OIG), found that CMS had made more than $616 billion Medicare Advantage (MA) payments between 2012 and 2015. However, over that same time frame, the agency made 1.8 million adjustments to capitation payments, recouping $2.96 billion from MA organizations for Part A and Part B payments issued for deceased beneficiaries after their date of death.
However, according to the audit, CMS did not identify and recover all of the incorrect capitation payments. OIG in the report stated, "As of March 7, 2017, CMS had not recouped $2.4 million associated with 1,817 capitation payments that were made on behalf of 978 deceased beneficiaries. For our audit period, these improper payments represented .0004 percent of the total capitation payments made to MA organizations and .08 percent of the total adjustments that CMS made after receiving information on beneficiaries' dates of death."
In the report, OIG advised CMS to "recoup the $2.4 million in capitation payments made to MA organizations for Medicare Parts A and B services on behalf of deceased beneficiaries, and … implement system enhancements to identify, adjust, and recoup improper capitation payments in the future."
CMS said it agreed with the recommendations and have taken corrective action (Commins, HealthLeaders Media, 10/12).
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