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Inmates Getting Millions In Improper Medicare Benefits, Trend Likely To Continue

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Centers for Medicare and Medicaid (CMS) officials paid nearly $35 million in benefits to prison inmates in 2013 and 2014, a pattern that will likely continue, according to a new Health and Human Services (HHS) Office of Inspector General (IG) report.

“The data that the Centers for Medicare and Medicaid Services (CMS) uses (and plans to use in the future) to ensure payments are not made for Medicare services rendered to incarcerated beneficiaries are not sufficient for its policies and procedures to comply with Medicare requirements,” the report said.

“CMS currently does not perform post-payment edits to detect and recoup improper payments, and CMS plans to use data that are suitable for processing Social Security payments but not Medicare payments,” the report continued.

Federal law requires CMS to halt Medicare payments as soon as a person goes to jail, but CMS officials haven’t checked for mistakes or recovered benefits sent in error since at least 2013. Hence, CMS officials wasted nearly $35 million. CMS plans to fix the problem by denying Medicare payments to prisoners for the same periods the Social Security Administration (SSA) denies benefits.

But SSA only suspends benefits after a person is convicted and incarcerated for at least 30 days, so someone could receive improper Medicare benefits for months or years while awaiting conviction, the report said.

CMS agreed with the IG’s recommendation to review and recover the nearly $35 million it paid to prisoners over 2013 and 2014, but disagreed with the IG’s recommendation to find a more accurate system for checking incarceration dates and denying benefits prohibited by law. (RELATED: Social Security Administration Sends $165 Million To Dead People)

“As long as Medicare requirements define incarceration differently than SSA does and as long as CMS relies on SSA suspension data to adjudicate claims for incarcerated beneficiaries, CMS will not be in full compliance with those requirements,” the report said.

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