Qui Tam

Medicare Paid Millions for Care Supposedly Provided to Dead People

By Nolan and Auerbach

HHS-OIG released the results of an audit it conducted looking into Medicare Parts A and B services billed with dates of service after the beneficiaries? death. Based on its findings, it estimates that Medicare shelled out over $8.2 million in overpayments for Medicare Part B claims with dates of service after the beneficiaries’ deaths.  

Under federal regulations, Medicare only pays for expenses incurred for items or services that were reasonable and necessary. Obviously, because medically necessary services cannot be provided after a beneficiary dies, payments for claims with dates of service after a beneficiary’s death are overpayments.  

Notably, while Medicare had already recouped most of the Part A payments prior to the audit, the vast majority of the improper Part B payments were never identified or recovered. Medicare Part B payments cover such expenses as durable medical equipment (DME) and outpatient treatments.

As evident by these findings, the government needs the assistance of whistleblowers to identify fraudulent DME suppliers, who seek to continue billing Medicare well after a patient dies.

For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

Full post as published by Medicare Fraud 101 on October 01, 2010 (boomark / email).