In 1998 and 1999, Medicare Improperly Paid $850K for Services for Deported Beneficiaries

Medicare in 1998 and 1999 spent about $850,000 on health services for beneficiaries who were deported by the federal government because of "criminal backgrounds and convictions," according to an audit report released April 3 by the HHS Office of Inspector General. The report, requested by the Senate Finance Committee, examined records of 1,072 deported beneficiaries and found that 49 beneficiaries had received Medicare benefits after they had been deported. Medicare paid $688,933 in fee-for-service benefits for 43 deportees and $147,788 in managed care benefits for six deportees, the report found. In some cases, deportees returned to the United States and illegally received services paid for by Medicare, while in other instances, deportees' Medicare cards were used by other, ineligible people. The report also found that some Medicare providers "mistakenly or fraudulently billed the program" for services administered to deportees. Although CMS maintains records of deported Medicare beneficiaries, it does not refer to such information when processing Medicare claims, the report noted.

Recommendations
The report recommended that CMS automatically deny fee-for-service claims and stop payments to managed care plans for services received by deported beneficiaries. The report also suggested that CMS return deported beneficiaries' fee-for-service claims to claims processors for collection and investigate overpayments to deported beneficiaries' managed care plans. The inspector general concluded that "unless CMS strengthens its internal control structure, future payments made on behalf of deported individuals will not only happen, but may increase." CMS responded to the report by saying that it "generally concurred with the IG's recommendations" (Teske, BNA News Medicare Report, 4/5). The full OIG report is available online. Note: You must have Adobe Acrobat Reader to view the report.