Medicaid Managed Care Companies in Ohio Received $90 Million in Payments for Dead People

Reported in a shocking report released this week, the Office of Inspector General for the U.S. Department of Health found that the Ohio Department of Medicaid made $90.5 million in capitation payments to managed care organizations in the state on behalf of deceased beneficiaries.

Over 81,000 payment made over two years

The audit covered a two-year period from July 1, 2014, to June 30, 2016, and found some 81,841 payments had been made.

The OIG audit paired the Medicaid Management Information System data to the Social Security Death Master File using the beneficiaries’ social security numbers, names, and dates of birth.  They then identified all capitation payments that occurred at least 1 month after the beneficiaries’ dates of death.

Owes federal government $38 million

The auditors then selected a random sample of 100 capitation payments that totaled $195,233 and went on to confirm that the beneficiaries were indeed dead and that the payments had been made.  It was found that the Ohio Department of Medicaid had recovered payments for 37 of these 100 from MCOs but the remaining 67 had not been.  They then estimated that for the time period in question that Ohio hadn’t collected back some $51.3 million and owed the federal government their share of $38 million.

The summary report is below.

State didn’t always identify and process death information

OIG found that “Ohio did not always identify and process Medicaid beneficiaries’ death information. Although Ohio’s eligibility systems regularly interfaced with Federal data exchanges that identify dates of death, county caseworkers did not always receive notification that beneficiaries had died.”

The state did not agree or disagree with the audit recommendations.

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