If Ohio Bills Medicaid For The Dead, Then How Much Do They Bill For The Kids?

Iowa is not the only state with paying the dead.

If you think this is bad, consider what they do in child welfare, or rather foster care and adoption.

Once a child is placed under the aegis of the state, upon termination of parental rights, new identities are issued.

Does this mean the "death" of the original personnae of the child, before the new adoptive name is assigned, is eligible for posthumous Medicaid Targeted Case Management cost reimbusements?

Sometimes, I wonder if there are billing opportunities for children born and die in foster care.

Until the U.S. Department of Health and Human Services Office of Inspector General does something more than just crank out audit reports, like refer to the FBI, one can only speculate as to the magnitude of Medicaid fraud in child welfare, whether the kids are dead or alive.

Ohio made capitation payments totaling $90.5 million on behalf of deceased beneficiaries. We confirmed that all beneficiaries associated with the 100 capitation payments in our stratified random sample were deceased. Ohio properly recovered 37 of these capitation payments. However, Ohio did not recover the remaining 63 capitation payments totaling $74,495 ($51,431 Federal share). On the basis of our sample results, we estimated that Ohio did not recover unallowable payments to MCOs totaling at least $51.3 million ($38 million Federal share) during our audit period. 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.

Where did the money go?

OIG: OHIO MEDICAID MANAGED CARE ORGANIZATIONS RECEIVED CAPITATION PAYMENTS AFTER BENEFICIARIES’ DEATHS by Beverly Tran on Scribd

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