Review of Medicare Payments to Prescription Drug Plans on Behalf of Deceased Enrollees

摘要

Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established the Medicare Part D prescription drug benefit. Medicare Part D offers Medicare beneficiaries prescription drug options for health care coverage. The Centers for Medicare & Medicaid Services (CMS) makes payments at the beginning of each month to prescription drug plan sponsors for direct, reinsurance, and low-income cost-sharing subsidies for individuals enrolled in prescription drug plans. After an enrollee dies, the last allowable payment is for the month in which the enrollee died. CMS has systems that identify deceased enrollees to initiate disenrollment and prevent improper payments made to prescription drug plan sponsors for the months following the enrollees' deaths. For the period July 1, 2005, through July 31, 2007, approximately 2.7 million Medicare enrollees (as identified on the Social Security Administration's (SSA) systems) died and had at some point been enrolled with prescription drug plan sponsors. Our objectives were to determine whether CMS (1) made payments on behalf of deceased Medicare enrollees to prescription drug plan sponsors for coverage periods after the enrollees' months of death and (2) recovered payments made on behalf of deceased enrollees on a timely basis.