Audit finds $10.5M in payments for procedures for dead people

[okarol]

Audit finds $10.5M in payments for procedures for dead people

By Laura A. Bischoff

Staff Writer, Dayton Daily News

Wednesday, December 20, 2006

COLUMBUS — The $10.2 million in Medicaid payments went for nursing home stays, prescription drugs and kidney dialysis for patients, auditors hired by the state found.

One problem: The patients were already dead. Nursing homes accounted for $9.8 million — or about 96 percent — of the post-mortem payments, auditors said.

The Ohio Department of Job and Family Services failed to reconcile the overpayments to the nursing homes. But Job and Family Services spokesman Jon Allen said the department switched to a new billing setup in 2005 that should address that problem.

State Auditor Betty Montgomery on Tuesday released an 800-page performance audit that looked at Ohio's $13 billion system and a separate report that examined 18 months of payments to Medicaid providers. The two audits cost $1.5 million.

"It paints a dismal picture of the Medicaid system," Montgomery said.

Auditors identified another $5 million in payments to nursing homes for days that patients had actually been staying in hospitals. Pharmacies billed Medicaid for 5,506 prescriptions dispensed after patients had died, auditors said. And managed-care firms, which are paid a flat fee for patient services, improperly billed Medicaid for $11.4 million for hospital stays.

In all, Montgomery suggested more than 100 changes that could save the state $403 million a year and found $42.4 million in improper payments to providers. One area has been referred to the U.S. Attorney's office for investigation of possible fraud.

Ohio Medicaid is a state and federally funded health insurance program for 1.7 million low-income working families, elderly and disabled Ohioans.

"This certainly provides a framework that the incoming administration and the General Assembly will be able to work with," Allen said.
 
 
 
Find this article at:
http://www.daytondailynews.com/n/content/oh/story/news/local/2006/12/19/ddn122006audit.html

[Sara]

That's sad that SO much money has gone to waste basically.  I used to work for Florida Medicare, and I know the rules on when different plans/agencies should be billed rather than others was confusing much of the time - maybe that's part of the problem with Ohio Medicaid?

[kitkatz]

The entire system needs to be taken out and shot!

[Sluff]

When the govt gets involved...well nuff said.

[BigSky]

The people who submitted these bills to Medicaid committed fraud.  They are taking advantage of the system.

As such it should be a mandatory, no parole 5 years hard labor in prison for each count.

[Sluff]

Absolute fraud!!  Try accepting an overpayment from any Govt agency and see what happens to Joe Public...