We estimated that Minnesota made unallowable capitation payments totaling at least $3.7 million ($3.2 million Federal share) to MCOs on behalf of deceased beneficiaries during our audit period. Of the 100 capitation payments in our random sample, Minnesota made 95 unallowable payments totaling $62,665 ($55,932 Federal share).
The unallowable payments occurred because Minnesota did not always identify and process Medicaid beneficiaries’ death information. During our audit period, Minnesota was in the process of integrating a new eligibility and enrollment system that did not always properly interface with the MMIS, which Minnesota uses to process payments to MCOs.
Source: The Minnesota State Medicaid Agency Made Capitation Payments to Managed Care Organizations After Beneficiaries’ Deaths / U.S. Department of Health and Human Services Office of Inspector General