Improper Medicare Payments for Unlawfully Present, Incarcerated Beneficiaries

The OIG has discovered that Medicare has paid millions of dollars in benefits for aliens who are not lawfully present in the country and for incarcerated beneficiaries, contrary to program rules. Specifically Medicare made $91.6 million in payments to health care providers for services to approximately 2,600 unlawfully present beneficiaries during calendar years 2009 through 2011 because CMS did not always receive the unlawful presence information promptly. Likewise, because CMS did not always receive incarceration information promptly, Medicare paid $33.6 million for services to approximately 11,600 incarcerated beneficiaries during 2009 through 2011, even though prisons generally are responsible for paying for care (Medicare will make payments for incarcerated patients if state or local law requires the individuals to repay the cost of the services, but providers must submit such claims with an "exception code"). The OIG recommends that CMS ensure that its contractors recoup any improper payments, implement various policies and procedures to detect and recoup future improper payments, and standardize contractor processing of exception codes for incarcerated beneficiaries. Additional details can be found in the complete reports, Medicare Improperly Paid Providers Millions of Dollars for Unlawfully Present Beneficiaries Who Received Services During 2009 Through 2011 and Medicare Improperly Paid Providers Millions of Dollars for Incarcerated Beneficiaries Who Received Services During 2009 Through 2011.

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