Florida Paid an Estimated $26.2 Million on Behalf of Dead Beneficiaries in 5 Years

State had incorrect info, sometimes failed to update dates of death in database

December 21, 2016

The state of Florida paid managed care organizations roughly $26.2 million in Medicaid payments on behalf of dead beneficiaries in the span of five years, according to a report from the inspector general for the Department of Health and Human Services.

Managed care organizations provide a package of benefits to Medicaid enrollees. States contract with these organizations and pay them a fixed monthly rate per enrollee in return for the services.

The audit found that from July 1, 2009 through November 5, 2014, the state of Florida entered into 114 of these contracts with 37 managed care organizations.

During this time, the inspector general found that the state did not always stop making payments to these organizations after beneficiaries died.

In a random sample of 124 payments, the inspector general found that the state paid $192,273 on behalf of dead beneficiaries.

"These overpayments occurred because the State agency did not timely update the [date of death] in the Florida Medicaid Management Information System, and the beneficiaries' enrollments were not updated once they were identified as deceased," the report said.

Additionally, the state of Florida did not "collaborate with other state and federal agencies to determine the inconsistency between the sources of [date of deaths] or use additional sources or alternative procedures to determine the reason its data sources were inconsistent."

Based on the sample of 124 payments, the auditors estimated that the state made overpayments of $26,202,536 on behalf of dead beneficiaries.

The auditors recommended that the state recover the overpayments and implement procedures to identify and correct inaccurate death information.

"The agency has already recouped almost $24 million of the $26 million in overpayments," said Mallory McManus, a communications director at Florida's Agency for Health Care Administration. "In managed care, capitation payments are made for the upcoming month to ensure continuity of care and to prevent lapses in health care coverage."

Published under: Medicaid