Medicare Improperly Paid Providers Millions of Dollars For Entitlement-Terminated Beneficiaries Who Received Services During 2010 Through 2012

摘要

Medicare fee-for-service benefits are allowable for beneficiaries who meet the entitlement or eligibility requirements of the Medicare program. But when beneficiaries no longer meet these requirements, their entitlement to Medicare is terminated. We refer to these individuals as entitlement-terminated beneficiaries. Accordingly, any payments that Medicare makes to providers on behalf of entitlement-terminated beneficiaries are improper. We are conducting a series of reviews examining the Centers for Medicare & Medicaid Services (CMS) controls to prevent and detect improper payments. We previously reported that CMSs controls did not detect improper Medicare payments for beneficiaries who were not lawfully present in the United States ($91.6 million) or for beneficiaries who were incarcerated ($33.6 million). The objective of our audit was to determine whether CMS had adequate controls to prevent and detect improper payments for Medicare services rendered to entitlement-terminated beneficiaries. Medicare provides health insurance for people aged 65 and over, people with disabilities, and people with kidney disease. CMS, which administers the program, contracts with Medicare contractors to process and pay Medicare Parts A and B claims submitted by health care providers.