Department of Health and Human Services 
OFFICE OF 
INSPECTOR GENERAL 
Medicare Payments for Services 
After Date of Death 
JUNE GIBBS BROWN 
Inspector General 
MARCH 2000 
OEI-03-99-00200  OFFICE OF INSPECTOR GENERAL 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, is to 
protect the integrity of the Department of Health and Human Services programs as well as the 
health and welfare of beneficiaries served by them.  This statutory mission is carried out through a 
nationwide program of audits, investigations, inspections, sanctions, and fraud alerts.  The 
Inspector General informs the Secretary of program and management problems and recommends 
legislative, regulatory, and operational approaches to correct them. 
Office of Evaluation and Inspections 
The Office of Evaluation and Inspections (OEI) is one of several components of the Office of 
Inspector General.  It conducts short-term management and program evaluations (called 
inspections) that focus on issues of concern to the Department, the Congress, and the public.  The 
inspection reports provide findings and recommendations on the efficiency, vulnerability, and 
effectiveness of departmental programs. 
OEI's Philadelphia Regional Office prepared this report under the direction of Robert A. Vito, 
Regional Inspector General, and Linda M. Ragone, Deputy Regional Inspector General.  Principal 
OEI staff included: 
REGION  HEADQUARTERS 
David Graf, Project Leader  Stuart Wright, Program Specialist 
Tara Schmerling, Program Analyst  Brian Ritchie, Technical Support Staff 
To obtain copies of this report, please call the Philadelphia Regional Office at 1-800-531-9562. 
Reports are also available on the World Wide Web at our home page address: 
http://www.dhhs.gov/progorg/oei  E X E C U T I V E   S U M M A R Y  
PURPOSE 
To determine if Medicare is paying claims with service dates after a beneficiarys death. 
BACKGROUND 
The Health Care Financing Administration (HCFA), which administers the Medicare 
program, contracts with fiscal intermediaries and carriers to process claims.  In 1991, 
HCFA established the Common Working File (CWF) to improve claims processing in the 
Medicare program. 
Under the CWF system, intermediaries and carriers send the claim information to one of 
nine CWF host sites for approval.  These host sites are designated intermediaries and 
carriers responsible for maintaining the claims data received from other contractors.  At 
the host sites, checks are performed on the claim for consistency, entitlement, and 
duplication of services. 
The CWF host sites receive updated beneficiary information, including date of death, from 
HCFAs Enrollment Database on a daily basis.  The data contained in the Enrollment 
Database is received daily from the Social Security Administration and the Railroad 
Retirement Board.  In addition to receiving date of death information from the Enrollment 
Database, the CWF receives some date of death information directly from institutional 
claims submitted by intermediaries. 
For this inspection, we analyzed HCFAs Enrollment Database and a 1 percent sample of 
National Claims History data to identify services that started after a beneficiarys date of 
death.  We also surveyed selected intermediaries and carriers asking about their 
procedures for identifying and recovering payments made for deceased beneficiaries. 
FINDINGS 
Medicare paid $20.6 million in 1997 for services that started after a beneficiarys 
date of death 
Medicare paid an estimated $20.6 million in 1997 for services where the beneficiarys date 
of death preceded the start date of the service.  Medicare had not yet received date of 
death information at the time the claim was processed for $12.6 million (of $20.6 million) 
1 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  of the services paid.  Most of these claims (75 percent) were processed within 45 days of 
the beneficiarys date of death. 
Medicare paid $8 million (of $20.6 million) for services where the beneficiarys date of 
death was posted in its system at the time the claim was processed.  Over half ($4.8 
million) was for durable medical equipment (DME) claims.  We also found some payments 
for Part A and Part B services where the Enrollment Database and CWF files contained 
different dates of death. 
Medicare does not have uniform post-payment procedures to identify and recover 
payments for deceased beneficiaries 
Of the 15 contractors we surveyed, only 2 had post-payment procedures in place to 
identify payments for deceased beneficiaries.  Four other contractors are in the process of 
developing review procedures. 
RECOMMENDATIONS 
One piece of information that the Common Working File (CWF) uses when processing a claim is 
a beneficiarys date of death.  We found that proper payment of a claim depends on (1) the receipt 
of date of death information before the claim is processed or (2) accurate system edits based on 
date of death information already in the CWF system.  In either case, we believe that payments 
should not be made for services starting after a beneficiarys date of death.  Therefore we 
recommend: 
The HCFA should require Medicare contractors to conduct annual post-payment 
reviews to identify and recover payments for services after death 
Our findings show that HCFA made substantial payments for services where the 
beneficiarys date of death was not yet posted at the CWF at the time the claim was 
processed and approved for payment.  Because claims like these cannot be denied prior to 
payment (since the date of death is not in the CWF system), we recommend that HCFA 
require their contractors to conduct annual post-payment reviews to identify and recover 
these payments. 
We also found that contractors internal claims processing systems may be missing a 
significant amount of beneficiary date of death information.  Therefore, HCFA should 
coordinate with their contractors to ensure they have the most up-to-date beneficiary date 
of death information before performing their post-payment reviews. 
2 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  The HCFA should revise their CWF system edit to ensure that DME payments are 
not made for deceased beneficiaries 
We found particular problems relating to DME payments for deceased beneficiaries when 
the CWF had date of death information at the time the claim was processed and approved 
for payment.  We recommend that HCFA revise their current CWF edit to deny all DME 
claims where the start dates of service occur after a beneficiarys death.  We believe that 
$4.8 million in 1997 payments for deceased beneficiaries would have been avoided had 
such an edit existed.  In addition, we believe that HCFA policy should require that start 
and ending dates for DME services accurately reflect the service period. 
The HCFA should periodically reconcile date of death information between the 
Enrollment Database and CWF files 
We found that for some beneficiaries, discrepancies existed between the dates of death 
posted on the Enrollment Database and the dates of death posted at the CWF.  Inaccurate 
date of death information can cause claims to be paid incorrectly and can also affect the 
accuracy of post-payment reviews.  Therefore, we recommend that HCFA periodically 
reconcile the date of death information to ensure that accurate dates of death are 
contained in both files. 
AGENCY COMMENTS 
The HCFA concurred with our recommendations.  In April 1999, HCFA completed their 
own program vulnerability analysis of this issue and developed an action plan to address 
the issues identified in their report.  To specifically address our recommendations, HCFA 
stated that they would (1) fund pilot projects for a subset of Medicare contractors to 
identify and investigate improper payments for deceased beneficiaries, (2) require all 
contractors to perform post-payment reviews as part of their FY 2001 Budget 
Performance Requirements, (3) establish the system changes necessary to revise their 
Common Working File edit, and (4) work to reconcile date of death information while 
controlling contractors workloads.  The full text of HCFAs comments can be found in 
Appendix B. 
3 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  T A B L E   O F   C O N T E N T S  
EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

INTRODUCTION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Payments After Death  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Identification and Recovery of Payments After Death . . . . . . . . . . . . . . . . . . . . . . . . . . 11

RECOMMENDATIONS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  12

APPENDICES

A: Estimates and Confidence Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

B. Agency Comments  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

4 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  I N T R O D U C T I O N  
PURPOSE 
The purpose of this inspection is to determine if Medicare is paying claims with service 
dates after a beneficiarys death. 
BACKGROUND 
The Health Care Financing Administration (HCFA), which administers the Medicare 
program, contracts with companies called fiscal intermediaries and carriers to process 
claims.  Fiscal intermediaries reimburse institutional inpatient services under Medicare Part 
A and outpatient claims under Part B.  The types of institutional providers submitting 
claims to intermediaries include hospitals, skilled nursing facilities, and home health 
agencies.  Carriers reimburse all other Part B claims including claims for services provided 
by physicians and medical suppliers.  Four carriers called durable medical equipment 
regional carriers (DMERCs) process claims for durable medical equipment, prosthetics, 
orthotics, and supplies. 
Claims Processing 
In 1991, HCFA established the Common Working File (CWF) to improve claims 
processing in the Medicare program.  Under the CWF system, intermediaries and carriers 
no longer contact HCFA directly to verify information such as beneficiary entitlement and 
benefit status before paying a claim.  Instead, they send the claim information to one of 
nine CWF host sites.  The CWF host sites are designated intermediaries and carriers 
responsible for maintaining the claims data received from other contractors. 
Before sending a claim to the CWF host sites, intermediaries and carriers enter the claim 
into their processing system, perform consistency and utilization edits on the claim, and 
calculate a payment amount.  Then they send the claim to one of the host sites.  At the 
host sites, checks are performed on the claim for consistency, entitlement, and duplication 
of services.  Once the host sites perform these edits, they authorize the intermediary or 
carrier to pay the claim, reject the claim, or hold the claim until more information is 
obtained. 
Date of Death Information 
The CWF host sites receive updated beneficiary information, including date of death, from 
HCFAs Enrollment Database on a daily basis.  The Enrollment Database contains 
5 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  information for each beneficiary ever enrolled in Medicare including personal identifiers 
such as name and social security number, demographic data such as date of birth and date 
of death, and entitlement information including start and termination dates.  The data 
contained in the Enrollment Database is received daily from the Social Security 
Administrations (SSA) Master Beneficiary Record which contains demographic and 
entitlement data on all Medicare beneficiaries.  The SSA can be notified of a beneficiarys 
death in a number of ways including reports from relatives, funeral homes, or the postal 
service. 
In addition to receiving date of death information from the Enrollment Database, the CWF 
receives some date of death information directly from institutional claims submitted by 
intermediaries.  On these claims, the ending date of service indicates the date of the 
beneficiarys death. 
Program Vulnerability 
In April 1999, HCFA issued a draft report which identified payments for deceased 
beneficiaries as a program vulnerability.  According to HCFA, this vulnerability stems 
from the late posting of a beneficiarys date of death to the SSA and the subsequent 
posting of this information to the CWF.  The HCFA has notified their contractors of this 
vulnerability and at their 1999 benefit integrity training sessions suggested that contractors 
perform data analysis to identify billings for deceased beneficiaries. 
METHODOLOGY 
This inspection focused on the receipt of data at the CWF level to determine if Medicare 
paid claims for services after a beneficiarys date of death.  We did not evaluate whether 
or not the SSA received beneficiary date of death information in a timely manner. 
Claims Data 
We gathered all 1997 claims for a 1 percent sample of Medicare beneficiaries using 
HCFAs National Claims History file.  To identify services that started after a beneficiarys 
date of death, we first developed a list of unique beneficiary identification numbers in the 
sample.  We then matched those numbers against HCFAs Enrollment Database, checking 
for beneficiaries who had died prior to January 1, 1998.  We then extracted from the 1 
percent sample all claims associated with these deceased beneficiaries.  We calculated the 
number of services and dollars paid where the start date of service was after the date of 
death.  We used the amount that Medicare reimbursed, which does not include beneficiary 
co-payments or deductibles, to calculate dollars paid. 
6 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  For the purposes of this report, when we refer to Part A services, we are referring to both 
Part A inpatient services as well as Part B outpatient services handled by fiscal 
intermediaries.  When we refer to Part B services, we are referring to Part B services 
handled by carriers.  When we refer to durable medical equipment (DME) services, we are 
referring to the durable medical equipment, prosthetics, orthotics, and supplies handled by 
the DMERCs. 
Variables used in analysis.  To determine if the CWF had a beneficiarys date of death at 
the time the claim was processed, we used information from the Enrollment Database and 
National Claims History files.  To determine when the CWF received the beneficiarys 
date of death, we used the Enrollment Database variable SSA RRB Action Processing 
Date (Last Action Date).  This variable is defined as the date of the last Social Security 
Administrations Master Beneficiary Record (MBR) or Railroad Retirement Board 
change. 
To determine when Medicare processed the claim, we used the National Claims History 
variable CWF Accretion Date (Processing Date).  This variable is defined as the date the 
institutional or Part B claim is accreted (posted/processed) to the MBR at the CWF host 
site and authorization for payment is returned to the fiscal intermediary or carrier. 
The HCFA informed us that the Enrollment Database ledger account file (LAF) codes may 
be more indicative than the Last Action Date in determining when a beneficiarys date of 
death is recorded at the Enrollment Database.  However, we compared the Last Action 
Date to the LAF code defined as the beneficiary payment status change date (LAF date). 
Our analysis showed that the LAF date was either the same or prior to the Last Action 
Date.  To be conservative in determining when Medicare had the beneficiarys date of 
death, we used the Last Action Date in our analysis. 
Comparing Last Action Date to Processing Date.  We compared the Last Action Date 
to the Processing Date.  Usually it takes one day for the date of death information to go 
from the SSA to the Enrollment Database and another day to go from the Enrollment 
Database to the CWF.  We added three days to the Last Action Date to allow for the 
maximum time it would take for the date of death data to get from the SSA to the CWF. 
If the Processing Date was before the Last Action Date (plus 3 days), we determined that 
the CWF host site processed the claim before the date of death was in the system.  If the 
Processing Date was after the Last Action Date (plus 3 days), we determined that the 
CWF host site processed the claim after the date of death was in the system. 
We performed further analysis on beneficiaries with Part A and Part B services where it 
appeared that the claim was processed after the date of death was posted at the CWF.  In 
order to check these dates of death, we reviewed the CWFs Health Insurance Master 
Record file.  Our analysis showed that, for a few services, the date of death had not made 
7 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  it from the Enrollment Database to the CWF.  For these beneficiaries, there was no date of 
death present on the CWFs Health Insurance Master Record file.  Therefore, in our 
calculations we grouped the services for these beneficiaries with the services where the 
CWF processed the claim before the date of death was in the system. 
Percentage estimates and corresponding 95 percent confidence intervals for our data were 
computed using standard statistical formulas for a simple random sample.  Point estimates 
and confidence intervals for all statistics presented in this report are in Appendix A. 
Survey Data 
We mailed questionnaires to 15 contractors asking about their post-payment procedures 
for identifying and recovering payments made for deceased beneficiaries.  We selected the 
top contractors based on their 1997 payments for deceased beneficiaries.  Whether or not 
contractors had post-payment procedures in place in 1997 is independent of the amount of 
their 1997 payments for deceased beneficiaries.  Our sample included five fiscal 
intermediaries, six carriers, and all four DMERCs. 
_____________ 
This inspection was conducted in accordance with the Quality Standards for Inspections 
issued by the Presidents Council on Integrity and Efficiency. 
8 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  F I N D I N G S  
Medicare paid $20.6 million in 1997 for services that started 
after a beneficiarys date of death 
Medicare paid an estimated $20.6 million in 1997 where the beneficiarys date of death 
preceded the start date of the service.  The $20.6 million represents $9.2 million in durable 
medical equipment (DME) claims, $10 million in Part A claims, and $1.4 million in Part B 
claims. 
For some of these services, our analysis revealed that the CWF had not yet received the 
beneficiarys date of death at the time the claim was processed.  However in other cases, 
the CWF had the beneficiarys date of death in its system when the claim was processed 
and approved for payment. 
Medicare had not yet received beneficiarys date of death for over half the 
payments 
Medicare paid $12.6 million (of $20.6 million) for services where the beneficiarys  date 
of death was not yet posted at the CWF at the time the claim was processed.  This $12.6 
million consisted of $4.5 million in DME claims, $6.9 million in Part A claims, and $1.2 
million in Part B claims.  Most of these claims (75 percent) were processed within 45 days 
of the beneficiarys date of death. 
Medicare had received beneficiarys date of death for almost half the payments 
Medicare paid $8 million (of $20.6 million) for services where the beneficiarys date of 
death was posted in the CWF at the time the claim was processed and approved for 
payment.  Over half ($4.8 million) was for DME claims.  The rest of the payments 
involved different dates of death in the Enrollment Database and CWF files. 
Payments for DME services after beneficiarys date of death 
We found that Medicare paid $4.8 million for DME services even though the CWF 
contained the beneficiarys date of death at the time the claim was approved for payment. 
Rental services accounted for $3.5 million of the $4.8 million in DME services.  The 
remaining payments consisted of non-rental DME services such as lump sum payments for 
DME, orthotics, and prosthetics and enteral nutrients.  The start and ending dates for 
these DME services occurred within 30 days of a beneficiarys date of death. 
9 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  We are aware that the CWF has an edit that allows for the payment of DME rental claims 
up to 30 days after a beneficiarys date of death.  This edit takes the beneficiarys date of 
death, adds 30 days, and compares this date with the service ending date to determine if 
the claim should be paid.  If the service ending date is before the beneficiarys date of 
death (plus 30 days) then the CWF allows the claim.  If the service ending date is after the 
beneficiarys date of death (plus 30 days) then the CWF denies the claim. 
It is our understanding that this edit was designed to allow for a full months rental 
payment if the beneficiary dies within the rental period.  For example, if the rental period 
for a DME service is March 1st (i.e., start date) thru March 31st (i.e., ending date) and the 
beneficiary dies on March 15th, the rental service for the month of March would be 
properly allowed since March 31st (i.e., service ending date) is before April 15th (i.e., date 
of death plus 30 days) and the beneficiary died within the rental period.  Additionally, a 
claim for the next rental period (April 1st -April 30th ) would be properly denied. 
However, all the rental claims that we identified had the same start and ending dates of 
service; therefore Medicares payment of these claims was actually for the rental period 
following a beneficiarys death.  For example, if the start and ending dates of service for 
an April rental period are April 1st and the beneficiary dies on March 15th, the CWF would 
improperly allow the claim for the month of April.  In this case, the edit says to allow the 
claim since April 1st (service ending date) is before April 15th (date of death plus 30 days). 
We also found similar payments made for DME claims that were not rental services.  For 
these claims, the start date of service was after the beneficiarys date of death and the 
service ending date was within 30 days of the beneficiarys death.  It appears that the 
CWF edit was applied not only to rental services but also non-rental services. 
Some Part A and Part B services had different dates of death in the Enrollment 
Database and CWF files 
We found some Part A and Part B services where the Enrollment Database and CWF files 
contained different dates of death.  As previously mentioned, the CWF can receive date of 
death information from both the Enrollment Database and from Part A claims.  For the 
services we identified, the CWF file reflected the dates of death contained on a Part A 
claim which was different from the dates of death posted on the Enrollment Database.  We 
found no indication of which file contained the accurate date of death. 
10 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  Medicare does not have uniform procedures to identify and 
recover payments for deceased beneficiaries 
Of the 15 contractors we surveyed, only two durable medical equipment regional carriers 
(DMERCs) had post-payment procedures in place to identify and recover payments made 
for deceased beneficiaries.  These two DMERCs identified approximately $1.2 million 
over a 2-year period for services paid after a beneficiarys date of death.  In contrast, we 
estimate that these same DMERCs paid $4.9 million in payments for deceased 
beneficiaries in 1997 alone.  Four other contractors (three carriers and one intermediary) 
are in the process of developing post-payment procedures. 
Three contractors specifically stated that they obtain (or will obtain) their beneficiary date 
of death information from their own internal claims processing system.  It is our 
understanding that contractors generally receive updated beneficiary information, 
including date of death, from the CWF when a claim is returned to the contractors. 
If a contractor submits a claim for a deceased beneficiary before the CWF has the 
beneficiarys date of death in its system, this claim will be approved for payment (barring 
any other problems with the claim).  Moreover, once the CWF is notified of the 
beneficiarys date of death, the contractors internal system is only updated if the 
contractor sends another claim to the CWF.  Therefore, it is possible that the contractors 
systems may never be updated with this beneficiary date of death information.  In turn, 
when the contractors perform their post-payment reviews looking for payments made for 
deceased beneficiaries, they may miss a significant number of payments because the 
beneficiarys date of death was never posted to their own internal claims processing 
system. 
11 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  R E C O M M E N D A T I O N S  
One piece of information that the Common Working File (CWF) uses when processing a claim is 
a beneficiarys date of death.  We found that proper payment of a claim depends on (1) the receipt 
of date of death information before the claim is processed or (2) accurate system edits based on 
date of death information already in the CWF system.  In either case, we believe that payments 
should not be made for services starting after a beneficiarys date of death.  Therefore we 
recommend: 
The HCFA should require Medicare contractors to conduct annual 
post-payment reviews to identify and recover payments for services 
after death 
Our findings show that HCFA made substantial payments for services where the 
beneficiarys date of death was not yet posted at the CWF at the time the claim was 
processed and approved for payment.  Because claims like these cannot be denied prior to 
payment (since the date of death is not in the CWF system), we recommend that HCFA 
require their contractors to conduct annual post-payment reviews to identify and recover 
these payments. 
We also found that contractors internal claims processing systems may be missing a 
significant amount of beneficiary date of death information.  Therefore, HCFA should 
coordinate with their contractors to ensure they have the most up-to-date beneficiary date 
of death information before performing their post-payment reviews. 
The HCFA should revise their CWF system edit to ensure that DME 
payments are not made for deceased beneficiaries 
We found particular problems relating to DME payments for deceased beneficiaries when 
the CWF had date of death information at the time the claim was processed and approved 
for payment.  We recommend that HCFA revise their current CWF edit to deny all DME 
claims where the start dates of service occur after a beneficiarys death.  We believe that 
$4.8 million in 1997 payments for deceased beneficiaries would have been avoided had 
such an edit existed.  In addition, we believe that HCFA policy should require that start 
and ending dates for DME services accurately reflect the service period. 
12 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  The HCFA should periodically reconcile date of death information 
between the Enrollment Database and CWF files 
We found that for some beneficiaries, discrepancies existed between the dates of death 
posted on the Enrollment Database and the dates of death posted at the CWF.  Inaccurate 
date of death information can cause claims to be paid incorrectly and can also affect the 
accuracy of post-payment reviews.  Therefore, we recommend that HCFA periodically 
reconcile the date of death information to ensure that accurate dates of death are 
contained in both files. 
AGENCY COMMENTS 
The HCFA concurred with our recommendations.  In April 1999, HCFA completed their 
own program vulnerability analysis of this issue and developed an action plan to address 
the issues identified in their report.  To specifically address our recommendations, HCFA 
stated that they would (1) fund pilot projects for a subset of Medicare contractors to 
identify and investigate improper payments for deceased beneficiaries, (2) require all 
contractors to perform post-payment reviews as part of their FY 2001 Budget 
Performance Requirements, (3) establish the system changes necessary to revise their 
Common Working File edit, and (4) work to reconcile date of death information while 
controlling contractors workloads.  The full text of HCFAs comments can be found in 
Appendix B. 
13 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  A P P E N D I X  A  
Estimates and Confidence Intervals

The tables below contain statistical estimates presented in the findings section of this report. 
Point estimates and corresponding 95 percent confidence intervals based on a 1 percent sample of 
HCFAs National Claims History file were computed using standard statistical formulas for a 
simple random sample. 
Table 1.  1997 Medicare Payments for Services After Date of Death 
Type of Service  Point Estimate  95% Confidence Interval 
DME  $9,243,771  $8,300,536  - $10,187,007 
Part A  $9,957,253  $3,367,049  - $16,547,457 
Part B  $1,434,529  $1,237,944  - $1,631,114 
Total  $20,635,553  $13,482,383  - $27,788,723 
Table 2. 	 1997 Payments Where Medicare Did Not Have Beneficiarys Date of Death 
When Claim was Processed 
Type of Service  Point Estimate  95% Confidence Interval 
DME  $4,480,453  $3,786,867  - $5,174,038 
Part A  $6,877,164  $3,162,325  - $10,592,003 
Part B  $1,215,769  $1,031,598  - $1,399,940 
Total  $12,573,386  $8,353,906  - $16,792,866 
14 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  A P P E N D I X  A  
Table 3. 	 Percentage of Claims Processed Within 45 Days of the Beneficiarys Date of Death 
When Date of Death Was Not in CWF System at the Time Claim was Processed 
Point Estimate  95% Confidence Interval 
Percentage of Claims Processed 
within 45 Days of the  74.82%  71.24%  - 78.40% 
Beneficiarys Date of Death 
Table 4. 	 1997 Total Payments Where Medicare Had Beneficiarys Date of Death When 
Claim was Processed 
Point Estimate  95% Confidence Interval 
Total Payments Where 
Medicare Had Beneficiarys  $8,062,167 *  $2,284,074  - $13,840,260 
Date of Death 
* In the findings of this report, we used $8 million as the estimate. 
Table 5.  1997 DME Payments Where Medicare Had Beneficiarys Date of Death When 
Claim Was Processed 
Type of Service  Point Estimate  95% Confidence Interval 
DME Total  $4,763,318  $4,126,468  - $5,400,169 
DME Rental  $3,506,073  $3,113,665  - $3,898,481 
15 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  A P P E N D I X  A  
Table 6.  Two DMERCs 1997 Payments for Services After Date of Death 
Point Estimate  95% Confidence Interval 
Two DMERCs 1997 
Payments for Services  $4,940,063  $4,459,786  - $5,420,340 
After Date of Death 
16 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  A P P E N D I X  B  
Comments From the Health Care Financing Administration

17 
Medicare Payments for Services After Date of Death  OEI-03-99-00200  A P P E N D I X  B  
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Medicare Payments for Services After Date of Death  OEI-03-99-00200  A P P E N D I X  B  
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Medicare Payments for Services After Date of Death  OEI-03-99-00200  A P P E N D I X  B  
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Medicare Payments for Services After Date of Death  OEI-03-99-00200  A P P E N D I X  B  
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Medicare Payments for Services After Date of Death  OEI-03-99-00200