I pay dead people
Jacqueline Vance, RN
On Oct. 31 (an ironic coincidence?) a report from the Office of inspector General frighteningly said Medicare paid some $23 million in benefits for more than 17,000 dead people in 2011. And my husband says I waste money. In my defense, I buy shoes for my living feet, but I digress.
The Día de los muertos — No wait, El Paga de los muertos — OIG report said Medicare paid the $23 million in benefits for 17,403 people who were dead (as “in a doornail”), with the majority of that amount through Medicare's private-insurance option, Medicare Advantage.
While most of the amounts paid were less than $1,000 per person, some were substantial — more than $50,000 in benefits for 12 people — who, again, were DEAD. Yet the living are killing themselves trying to get benefits! (Sorry, couldn't resist.)
The Government Watchdog report states, “Medically necessary services cannot occur after a beneficiary's death.” (You need advanced investigative skills to deduce medical interventions won't help dead people?)
The OIG has devoted numerous studies over the years (yes, we need years to show we keep paying for dead people) to detecting whether Medicare is paying bills submitted on behalf of the dead. The aim is to identify a variety of inadequacies in how them Center for Medicare & Medicaid Services receives death information from the Social Security Administration and then marries that data with the Medicare claims database.
Hmmm, Medicare Bride of Frankenstein might be my Halloween costume next year.
The report shows that Medicare Advantage, known as Part C, accounted for $20 million of the misspent funds. But, hey, those findings were already found in an OIG report from earlier this year (surely not taxpayer funded) that criticized Medicare's private auditors for failing to notice examples of dead-beneficiary billing. (Seriously, this has been going on for so long that “dead-beneficiary billing” is an actual term!)
By the way, private insurers that run the Medicare Advantage program are paid monthly to monitor for dead beneficiaries. This is a regular part of Medicare Advantage accounting based on their insured populations. When a beneficiary dies, the insurer has its monthly payment from the CMS docked by the corresponding amount. (Maybe the auditors are dead, too? Think “Zombie Apocalypse!”)
The OIG found a large concentration of billing for dead beneficiaries in Los Angeles, New York City and Miami. Guess you have to be careful because the “Walking Dead Auditors” must be in high numbers in those areas. Prepare for an Auditor Apocalypse?!
Again, another brilliant conclusion from the report states: “These providers and suppliers may be attempting to obtain payment for services that were not provided.” Again, really?
CMS officials responded to the OIG that they're in the process of investigating how to use existing computer data-mining tools to separate out providers for added analysis when they submit large numbers of bills for the dead. But isn't the problem that CMS doesn't know that they're dead, or am I missing something from the report?
Nonetheless, CMS states that if the model is viable (since government-built websites are so, ahem, reliable …), the system will go live (OK, that's the worst wordplay of them all here) in 2014. Sure hope it works on more than six people.
Looking forward to Halloween 2014 already, and just keeping it real,
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse who is also the director of clinical affairs for the American Medical Directors Association. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.