Department of Health and Human Services 
OFFICE OF 
 
INSPECTOR GENERAL 
 
 
 
 
 
M  P  
EDICARE  AYMENTS 
 
 M B
ADE ON  EHALF OF 
 
D   B  
ECEASED  ENEFICIARIES 
 
  2011 
IN 
 
Daniel R. Levinson   
Inspector General  
 
October 2013 
OEI-04-12-00130   
   
EXECUTIVE SUMMARY:  MEDICARE PAYMENTS MADE ON BEHALF OF 
DECEASED BENEFICIARIES IN 2011 
OEI-04-12-00130 
 
WHY WE DID THIS STUDY 
 
Prior Office of Inspector General (OIG) studies and audit reports have identified 
Medicare payments made on behalf of deceased beneficiaries. The Centers for Medicare 
& Medicaid Services (CMS) implemented safeguards to address this vulnerability.  
Health care fraud schemes have involved providers or suppliers submitting fraudulent 
claims to Medicare, including claims for deceased beneficiaries.  
 
HOW WE DID THIS STUDY  
 
We identified Medicare beneficiaries who, according to the Social Security 
Administration, died from 2009 to 2011.  We then identified Medicare Part A and B 
claims and Part C and D payments from 2011 associated with these deceased 
beneficiaries.  We also analyzed paid and unpaid Part B claims with service dates after 
beneficiaries deaths to identify providers and suppliers associated with high numbers of 
these claims. 
 
WHAT WE FOUND 
 
CMS has safeguards to prevent and recover Medicare payments made on behalf of 
deceased beneficiaries; however, it inappropriately paid $23 million (less than one-tenth 
of a percent of total Medicare expenditures) in 2011 after beneficiaries deaths.  Part C 
accounted for 86 percent of these improper payments.  Additionally, 11 percent of these 
improper payments resulted from missing or incorrect dates of death.  Further, we 
identified 251 providers and suppliers that had high numbers of paid and/or unpaid Part B 
claims with service dates after beneficiaries deaths. 
 
WHAT WE RECOMMEND   
 
We recommend that CMS (1) improve existing safeguards to prevent future improper 
Medicare payments after beneficiaries deaths, (2) take appropriate action on improper 
Medicare payments made on behalf of deceased beneficiaries and correct inaccurate dates 
of death, (3) monitor both paid and unpaid Part B claims with service dates after 
beneficiaries deaths, and (4) take appropriate action on providers and suppliers that had 
high numbers of paid and/or unpaid Part B claims with service dates after beneficiaries 
deaths. CMS concurred with all four recommendations.    
   
TABLE OF CONTENTS 
 
Objectives ....................................................................................................1 

Background..................................................................................................1 

Methodology................................................................................................8 

Findings......................................................................................................13 

CMS has safeguards to prevent and recover Medicare payments 

made on behalf of deceased beneficiaries; however, it 

inappropriately paid $23 million in 2011 after beneficiaries 
   
deaths .............................................................................................13 

Eleven percent of improper Medicare payments made on behalf  

of deceased beneficiaries resulted from missing or incorrect dates 

of death...........................................................................................16 

In 2011, 251 providers and suppliers had high numbers of         

paid and/or unpaid Part B claims with service dates after  

Medicare beneficiaries deaths .......................................................18 

Conclusion and Recommendations ............................................................20 

Agency Comments and Office of Inspector General Response .....22 

Appendixes ................................................................................................24 

A: Medicare Payments Made on Behalf of Deceased Beneficiaries 

by Year of Beneficiary Death .........................................................24 

B: Procedure Codes and Modifiers on Medicare Part B Claims 
 
With Service Dates After Beneficiaries Deaths ............................26 

C: Agency Comments  ...................................................................30 

Acknowledgments......................................................................................33 

 
   
   
OBJECTIVES 
1. 	  To identify and describe Medicare payments made on behalf of 
deceased beneficiaries.  
2. 	  To determine the accuracy of the Centers for Medicare & Medicaid 
Services (CMS) information on beneficiaries dates of death. 
3. 	  To identify providers and suppliers with paid and/or unpaid Part B 
claims with service dates after beneficiaries deaths. 
BACKGROUND 
Medicare should not pay for any expenses incurred for items or services 
that are not reasonable and necessary for the diagnosis or treatment of 
illness or injury or to improve the functioning of a malformed body 
member.1  Medically necessary services cannot occur after a beneficiarys 
death. Therefore, payments for services provided after a beneficiarys 
death are inappropriate. 
Prior Office of Inspector General (OIG) studies and audit reports have 
identified Medicare payments for claims with service dates after 
beneficiaries deaths.  For example, OIG found that Medicare paid 
$20.6 million in 1997 for Parts A and B services that started after 
beneficiaries deaths.2  Additionally, health care fraud schemes have 
involved providers or suppliers submitting fraudulent claims to Medicare, 
including claims for deceased beneficiaries.  For example, an individual 
was indicted on charges of health care fraud in 2008 because his durable 
medical equipment company submitted approximately $2.1 million in 
fraudulent Medicare claims for services that were not rendered, including 
10 claims for deceased beneficiaries.3   This individual fled to Cuba in 
2008 and was arrested as he attempted to enter the United States in 
 
June 2012.   
The Medicare Program 
CMS administers Medicare, a Federal health insurance program for the 
elderly and disabled.4  In 2011, total Medicare benefit outlays were 
 
1 Social Security Act  1862(a)(1)(A), 42  U.S.C.   1395y(a)(1)(A). 
2 Department of Health and Human Services (HHS) OIG,  Medicare Payments for 
Services After Date of Death  (OEI-03-99-00200), March 2000. 
3 HHS OIG,  Captured Fugitives:  CAPTURED: Miguel Cabello, June 2012.  Accessed at 
https://oig.hhs.gov/fraud/fugitives/captured_profiles.asp on March 13, 2013. 
4 CMS, Medicare Program  General Information: Overview, December 2005.   
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   1 
   
   
$541.3 billion.5    
Medicare has two components:  hospital insurance, otherwise known as 
Part A, and supplementary medical insurance, which consists of Parts B 
and D.6  Medicare also has Part C (i.e., Medicare Advantage), which 
serves as an alternative to the traditional fee-for-service approach of Parts 
A and B.7  Individuals who are eligible for Part A may enroll in Part B or 
join Medicare Advantage.  Additionally, individuals who are enrolled in 
Part A, Part B, or Medicare Advantage are eligible for prescription drug 
coverage under Part D. Table 1 provides a description and expenditures in 
2011 for each Part of Medicare.  
Table 1: Description and Benefit Outlays by Part of Medicare, 2011  
Percentage of 
Part of  2011 Medicare  Total 2011 
Description 
Medicare   Expenditures    Medicare 
Expenditures  
Helps pay for hospital, home health, skilled 
Part A  $188.3 billion   35%  
nursing facility, and hospice care  
Helps pay for physician outpatient hospital, home 
health, and other health services, including 
Part B  $162.6 billion   30%  
durable medical equipment, prosthetics, orthotics, 
and supplies (DMEPOS) 
Offers beneficiaries the option to enroll in and 
receive care from private Medicare Advantage 
Part C  $123.7 billion   23%  
plans and certain other health insurance plans 
that contract with Medicare  
Provides subsidized access to drug insurance 
coverage on a voluntary  basis for all beneficiaries 
Part D  $66.7 billion   12% 
and premium and cost-sharing subsidies for 
low-income enrollees  
     Total   $541.3 billion   100% 
Source:  See footnote 5 below. 
Part A services are furnished mainly by organizational providers (e.g., 
hospitals, home health agencies, skilled nursing facilities, and hospices).  
 
5 Board of Trustees of the Federal Hospital Insurance and Federal Supplementary 
Medical Insurance Trust Funds, 2012 Annual Report of the Board of  Trustees of the 
Federal Hospital Insurance and Federal  Supplementary Medical  Insurance Trust Funds, 
April 23, 2012. 
6 The Medicare  Prescription Drug, Improvement, and Modernization Act of  2003  
(MMA), P.L. 108-173, Title I, established  the Part D prescription drug benefit.  
7 The Balanced  Budget Act of  1997, P.L. 105-33,  4001, established the 
Medicare+Choice program, also  known as Medicare Part C.  Title II of the MMA revised 
Part C and established the Medicare Advantage program in place of Medicare+Choice. 
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   2 
   
   
Individual providers (i.e., physicians, nonphysician practitioners, and other 
qualified professional personnel) furnish most Part B services to Medicare 
beneficiaries. Other Part B services, such as home health services and 
outpatient therapy, may be furnished by or under the supervision of an 
organizational provider.  Suppliers generally provide DMEPOS items to 
beneficiaries under Part B. 
For certain Part A and B services and items, individual providers must 
order, refer, or certify the service or item for the beneficiary.  For example, 
individual providers must order certain nonphysician Part B items or 
services (e.g., DMEPOS, clinical laboratory services) for beneficiaries.  
Additionally, individual providers certify home health services for 
beneficiaries under Part A.8  Ordering/referring providers are listed on 
these nonphysician and home health claims even though suppliers or other 
providers are the entities that submit the claims to Medicare for payment.   
For Part C, beneficiaries may choose to enroll in Medicare Advantage 
plans (e.g., health maintenance organizations, preferred provider 
organizations) offered by private insurance companies (i.e., Medicare 
Advantage organizations).  Each Medicare Advantage organization can 
offer more than one plan to its beneficiaries.  Similarly, beneficiaries may 
choose to enroll in prescription drug plans to receive drug benefits 
subsidized by Part D. Private insurance companies (i.e., prescription drug 
plan sponsors) provide drug coverage to beneficiaries who choose to 
enroll. Each sponsor typically offers more than one prescription drug plan 
to its beneficiaries.   
Medicare Payment Processing  
Parts A and B. CMS relies on contractors to process and pay Parts A and 
B claims.  Claims processing contractors enter Medicare claims submitted 
by providers and suppliers into their processing systems, perform edits 
(system processes) on the claims, and calculate payment amounts.  Edits 
validate claims data by detecting errors or potential errors and verifying 
that certain data are consistent and appropriate.9  Edits are performed 
either before or after payment is made, depending on the type of edit.   
 
8 CMS, Medicare Enrollment Guidelines for Ordering/Referring Providers (Medicare 
Learning Network), September 2012.  Accessed at http://www.cms.gov/Outreach-and-
Education/Medicare-Learning-Network-
MLN/MLNProducts/downloads/MedEnroll_OrderReferProv_factSheet_ICN906223.pdf  
on  February 8, 2013.     
9 CMS, Medicare Administrative Contractor Workload Implementation Handbook  
(Legacy-to-MAC), February 2012.  Accessed at http://www.cms.gov/Medicare/Medicare-
Contracting/MedicareContractingReform/Downloads/Handbooks/Legacy2MACImp.pdf  
on  March 6, 2013.    
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   3 
   
   
The claims processing contractor then sends the claim to the Common 
Working File, where a series of edits are performed for consistency,  
entitlement, and duplication of services.10  Once the Common Working 
File completes its edits, the system authorizes the claims processing 
contractor to pay the claim, reject the claim, or hold the claim until more 
information is obtained. 
Parts C and D. At the beginning of each month, CMS makes payments on 
behalf of beneficiaries to Medicare Advantage organizations and 
prescription drug plan sponsors.11, 12   Payment amounts may differ for 
each enrolled beneficiary on the basis of demographic and health status  
information.13  CMS calculates payment amounts using the most current 
information available.   
If CMS receives demographic or health status information that would 
increase or decrease previous monthly Part C and/or D payments, it makes 
retroactive adjustments to correct the payment amount.14  For deceased 
beneficiaries, CMS corrects the payment amount for the months in which 
the individuals had, before their deaths, been enrolled in the Medicare 
Advantage plan or prescription drug plan.  The Medicare Advantage and 
Prescription Drug (MARx) system maintains information as to when 
beneficiaries enroll in or disenroll from a Medicare Advantage plan or a 
prescription drug plan. 
Date-of-Death Information 
To identify Medicare payments made on behalf of deceased beneficiaries,  
CMS relies on information in its Enrollment Database.  The Social 
Security Administration (SSA) and the Railroad Retirement Board (RRB) 
are CMSs primary sources of information about deceased  
 
10 The Common Working File contains all Medicare beneficiary information and Part A,
  
Part B, and DMEPOS claims transactions. CMS, Medicare Claims Processing Manual, 

Pub. 100-04, ch. 27,  10. 

11 For Part C, 42 CFR  422.304.  For Part  D,  42 CFR   423.315. 
  
12 For Part D, most beneficiaries are responsible for certain costs, which may include a 

monthly premium, an annual  deductible, and coinsurance or copayments.  However, 

certain low-income beneficiaries are eligible to receive a subsidy that pays some or all of 

these costs.  42 CFR  423.780 and 42 CFR   423.782. 

13 For Part C, 42 CFR  422.308(c).  For Part  D,  42 CFR   423.315. 

14 For Part C, 42 CFR   422.308 and  422.310(f).  CMS adjusts the payments monthly, 

as necessary, on both a prospective and retrospective basis to the beginning of the year.   

For Part D, 42 CFR  423.315 and 423.343.  After the end of each year, CMS reconciles 

levels of enrollment, risk factors, levels of incurred allowable drug costs,  reinsurance 

amounts, and low-income subsidies to determine reconciliation payment adjustments. 

Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   4 
   
   
beneficiaries.15, 16  SSA and RRB learn of beneficiaries deaths in a 
number of ways, including reports from relatives, funeral homes, and the 
U.S. Postal Service. Death notifications are processed by SSA and RRB 
as follows: 
 	  SSA processes death notifications through its Death Alert, Control, and 
Update System, which matches against the Master Beneficiary and 
Supplemental Security Records.17  SSA records the resulting death 
information in its Numerical Identification System (the Numident). 18   
SSA then uses information from the Numident to create a national 
record of death information called the Death Master File.19    
	   RRB processes death notifications through its Application Express 
System, which then populates the Medicare Information Recorded, 
Transmitted, Edited and Logged (MIRTEL) System.20         
CMS receives death information daily from SSAs Master Beneficiary 
Record and RRBs MIRTEL System.  When SSA or RRB has a specific 
date of death, CMS considers the date of death entered into the Enrollment 
Database to be verified for that Medicare beneficiary.   When SSA or RRB 
does not have a specific day of death, only a month of death, the last day 
of the month of death is entered into CMSs Enrollment Database.  CMS 
considers this date unverified because the database contains a default date 
 
of death.  Unverified death information in the Enrollment Database is 
updated as CMS, SSA, and RRB receive more specific (i.e., verified) 
information on beneficiaries dates of death. 
The Enrollment Database is the authoritative source of Medicare 
beneficiary information and contains personal identifiers (e.g., name, 
Social Security number), demographic data (e.g., date of birth, date of 
death), and entitlement information (e.g., benefit start date).21   The 
Enrollment Database is used to update beneficiary information in CMS 
 
15 RRB administers the retirement/survivor and unemployment/sickness insurance benefit 

programs for railroad workers and their families under the Railroad Retirement Act and 

the Railroad Unemployment Insurance Act.
    
16 Other sources for date-of-death information are institutional providers. 

17 SSA,  Programs Operations  Manual System, GN 02602.060  (May 13, 2011).  The 

Master Beneficiary Record is an electronic record  of all Title II (of the Social Security 

Act) beneficiaries. The Supplemental Security Record is an electronic record  of all Title 

XVI (of the Social Security Act) beneficiaries.   

18 Ibid. The Numident contains personally identifiable information for each individual 
 
issued a Social Security number. 

19  SSA, Programs  Operations Manual System, GN 02602.060.B.1 (May 13, 2011).   

20 RRB OIG, Audit of the Application Express (APPLE) Systems Date of Death 

Reliability (Report No. 12-06), March 2012.   

21 CMS, Data Directory.  Accessed at http://aspe.hhs.gov/datacncl/datadir/cms.htm on 

February 3,  2012. 
 
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   5 
   
   
systems, including the Common Working File and the MARx system.  
Once beneficiaries dates of death are entered in the Common Working 
File, any claims submitted with service dates after beneficiaries deaths are 
denied. Similarly, once beneficiaries dates of death are entered in the 
MARx system, the system disenrolls the deceased beneficiary from the 
Medicare Advantage plan or prescription drug plan at the end of the month 
in which the death occurred. 
Postpayment Review To Recover Improper Payments 
Beneficiary information may not always be accurate as a result of delays 
between the date a beneficiary dies and the date SSA learns of that death.  
Therefore, CMS may make improper payments after beneficiaries deaths; 
however, it retroactively recovers these payments once death information 
is received.  CMS identifies these improper payments differently 
depending on the Part(s) of Medicare in which the beneficiary is enrolled. 
Parts A and B. To identify and prevent payment for Part A and B services 
after beneficiaries dates of death, CMS implemented an informational 
unsolicited response process in April 2011.22  This process reviews all 
Part A and B claims approved for payment in the claims history and 
identifies claims with service dates up to 3 years after the beneficiarys 
date of death.23    
For example, if a beneficiary died on April 30, 2011, and the Common 
Working File system received notification of this beneficiarys death on 
May 16, 2012, the system will: 
 	  identify paid claims with service dates of April 30, 2011, to May 16, 
2012, 
 	  prompt an informational unsolicited responsei.e., an automated 
notificationto claims processing contractors for these identified paid 
claims with service dates after a beneficiarys date of death, and 
	   prevent any future improper payments for claims with service dates up 
to 3 years after the beneficiarys date of death. 
Claims processing contractors receive a report of identified claims for 
deceased beneficiaries on which they are required to take action and 
 
22 CMS, Change Request 7123, Transmittal 804, Pub.  100-020 One-Time  Notification,  
November 2010.  Accessed at  
https://www.cms.gov/transmittals/downloads/R804OTN.pdf on February 4, 2013.  The 
automatic adjustment process  of the informational unsolicited response retroactively 
adjusts certain paid claims when subsequent  claims or other subsequent actions are the 
first indicator that payment was inappropriate. 
23 Ibid.  
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   6 
   
   
perform additional review, if necessary, to determine whether payment 
was inappropriate.24  
Parts C and D.  When a beneficiary enrolled in a Medicare Advantage 
plan or prescription drug plan dies, the last payment should be for the 
month in which the beneficiary died.  CMS systems automatically 
disenroll deceased beneficiaries to prevent improper payments to 
Medicare Advantage organizations and prescription drug plan sponsors for 
the months following the deaths of enrolled beneficiaries.  CMS recoups 
any payments made to Medicare Advantage organizations and prescription 
drug plan sponsors on the behalf of deceased beneficiaries for such 
months. 
For example, if a beneficiary died in April 2011 and CMS received 
notification of this beneficiarys death in June 2011, the MARx system  
will automatically disenroll this beneficiary in June 2011 to prevent future  
improper payments.  Additionally, CMS will recoup the payments made to 
the Medicare Advantage organization and/or prescription drug plan 
sponsor for May and June. 
Related Work 
Prior studies and audit reports have identified Medicare payments after 
beneficiaries deaths, as well as issues with date-of-death information.  In 
2012, OIG reported that Medicare inappropriately paid $208,311 in 2010 
for home health services occurring after beneficiaries deaths.25  Similarly,  
OIG found that Medicare paid $20.6 million in 1997 for Part A and B 
services with service dates after beneficiaries deaths.26   Additionally, OIG 
found that in 2006 and 2007, Medicare paid $8.2 million for Part B claims  
with service dates after beneficiaries deaths,27 $4.4 million on behalf of 
deceased beneficiaries enrolled in Medicare Advantage plans, 28 and 
$3.6 million on behalf of deceased beneficiaries enrolled in prescription 
drug plans.29    
 
24 HHS OIG,  Review of Medicare Parts A and B Services Billed With Dates of Service 
After Beneficiaries Deaths  (A-01-09-00519), September 2010.  See CMSs comments. 

25 HHS OIG,  Inappropriate and Questionable Billing  by  Medicare Home Health 
 
Agencies (OEI-04-11-00240), August 2012. 

26 HHS  OIG,  Medicare Payments for Services After Date of Death (OEI-03-99-00200), 

March 2000. 

27 HHS OIG, Review of Medicare Parts A and B Services Billed With Dates of Service 

After Beneficiaries Deaths  (A-01-09-00519), September 2010. 

28 HHS OIG,  Review of Medicare Payments to Managed Care Plans on Behalf of
  
Deceased Enrollees (A-07-07-01046), March 2009.    

29  HHS OIG,  Review of Medicare Payments to Prescription  Drug  Plans on  Behalf of  

Deceased Enrollees (A-05-09-00027), May 2011. 

Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   7 
   
   
Other Federal programs have also made payments after beneficiaries  
deaths. For example, SSA OIG found that SSA made payments to more 
than 6,000 beneficiaries for months or years after receiving notification 
that the beneficiaries were deceased.30  Similarly, RRB OIG found that the 
postpayment review of Part B claims with service dates after the deaths of 
Railroad Retirement beneficiaries was inadequate to identify fraud and 
potential overpayments.31  Additionally, SSA OIG found that the 
Numident did not include death information for approximately 1.2 million 
beneficiaries who died between 1980 and 2010.32    
METHODOLOGY 
We identified individuals who, according to SSAs Death Master File, died  
between January 1, 2009, and December 31, 2011.  We then used CMSs 
Enrollment Database to determine whether these individuals had been 
enrolled in Medicare.33    
We identified Medicare Part A and B claims and Part C and D payments 
associated with these deceased beneficiaries from 2011.34    
	   For Part A, we analyzed outpatient, inpatient, home health, hospice, 
and skilled nursing facility claims from CMSs National Claims  
History Part A Standard Analytic Files for 2011.  We limited our 
analysis to Part A claims with reimbursement amounts greater than 
zero (i.e., paid claims).35    
	   For Part B, we analyzed claims for physician and nonphysician 
services and DMEPOS items from CMSs National Claims History 
Part B and DMEPOS Files for 2011.36  We analyzed Part B claims  
 
30 SSA OIG,  Payments  to Individuals Whose Numident Record  Contains a Death Entry  
(A-06-08-18095), June 2009.  
 
31 RRB OIG, Railroad Medicare Services Billed with  Dates of Service after the 

Beneficiaries Dates of Death (Report No. 10-13), September 2010. 

32 SSA OIG, Title II Deceased  Beneficiaries Who Do Not Have Death  Information on the 
Numident  (A-09-11-21171), July 2012.  Of those deceased beneficiaries whose deaths 
were not listed  on the Numident, 15,506  died in  2009 and 14,724  died in  2010. 
33 We used Social Security numbers to link deceased individuals from SSAs Death 
Master File to  Medicare beneficiaries in CMSs Enrollment Database. 

34  We  used the health insurance claim number to link deceased Medicare beneficiaries 

from the Enrollment Database to Part  A and B claims and to Part C and D payments. 

35 Medicare reimbursement amounts are the amount  of the payment  made to a Part  A 

provider by Medicare only (i.e., does not include any amounts paid  by the  beneficiary). 
  
Because we identified few Part A claims for deceased beneficiaries with reimbursement 

amounts of zeroi.e.,  unpaid claimswe analyzed only  paid Part A claims.   

36 Typically, a Part B provider or supplier bills for a set of services or items  on one claim, 
 
listing each service or item as a separate line item on that claim.  For the purposes of this 

report, we refer to line items  on claims as claims. 

Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   8 
   
   
with allowed amounts greater than or equal to zero (i.e., paid and 
unpaid claims).37, 38    
 	  For Parts C and D, we analyzed monthly payments from the MARx 
system for 2011.39    
In this report, we use the term Medicare payments to refer to 
reimbursement amounts from Part A claims, allowed amounts from Part B 
claims, and monthly Part C and D payments. 
Confirming Date-of-Death Information  
We compared the date-of-death information from SSAs Death Master File 
and CMSs Enrollment Database for each beneficiary.  For instances in 
which SSA and CMS listed different dates of death, we used Accurinta 
commercial data depositoryto confirm  whether these beneficiaries were 
deceased and the dates on which they died.40  When SSA and CMS date-
of-death information did not match, we used the date of death listed in 
Accurint for our analysis.  
Identifying Medicare Claims and Payments Made on Behalf of 
Deceased Beneficiaries 
Part A.  We analyzed outpatient, inpatient, home health, skilled nursing 
facility, and hospice claims data to determine the number of claims with 
service dates after beneficiaries dates of death.  We did not consider a 
claim to be inappropriate if it had a discharge code indicating that the 
beneficiary died during the stay and the beneficiarys date of death was 
1 day prior to the end-service date.41  For Part A claims in which the 
beneficiaries dates of death preceded the service dates, we summed 
payment amounts to calculate the overall amount that Medicare 
inappropriately paid for these services.   
 
37 Medicare-allowed amounts are 100 percent  of the payment made to a Part B provider  
or supplier by  both Medicare and the beneficiary.   Generally, Medicare pays 80 percent  
of allowed charges, and the beneficiary is  responsible for the remaining 20  percent.  
38 The National Claims History Files do  not contain all unpaid claims.  For example,  
claims  may have been submitted with service dates after beneficiaries  deaths that  were  
denied by  claims  processing contractors and  were not processed further.  
39 Includes retroactive adjustments of monthly Part C and D payments through August  
2012.   
40 Accurint is a LexisNexis data depository that contains more than  20  billion records 
from  more than  10,000  data sources.   Accurints primary source for dates of death is  
SSAs Death Master File.  Accurint also contains death information from obituaries and 
State death records.  We matched across beneficiaries social security numbers, first and 
last names, and dates of birth.  
41 On the claim,  the discharge status code indicates the beneficiary status at discharge.   
When a beneficiary dies prior to  discharge,  one of the following codes is entered:   
20 (expired), 40  (expired at home), 41 (expired in a medical facility), or 42  (expired, 
place unknown).    
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   9 
   
   
Part B.  Because of programmatic differences within Part B, we analyzed  
claims for physician and nonphysician services and claims for DMEPOS 
items differently.  Specifically: 
 	  We analyzed Part B claims for physician and nonphysician services to 
determine the number of claims with service dates after beneficiaries  
dates of death.  We did not consider claims to be inappropriate if they 
had modifier Q342 or modifier QL,43 were for discharge services 1 day 
after the beneficiary died,44 were for services on the same day as a 
discharge service that was 1 day after a beneficiarys death,45 or were 
for interpretation of tests up to 10 days after the beneficiarys death.46    
	   We analyzed Part B claims for DMEPOS items to determine the 
number of claims with service dates after beneficiaries deaths.  To  
account for the refill and rental requirements of certain DMEPOS 
items, we did not consider claims to be inappropriate if service dates 
were within 30 days of a beneficiarys date of death.47  
For Part B claims in which the beneficiaries dates of death preceded the 
service dates, we summed payment amounts to calculate the overall 
amount that Medicare inappropriately paid for these services and items.  
We also analyzed these Part B claims associated with deceased  
beneficiaries by procedure codes and modifiers.   
 
42 CMS, Medicare Benefit Policy Manual,  Pub. 100-02, ch. 11,  80.4.  Modifier Q3  
indicates that expenses for physicians services to the kidney donor are to be treated as 
though the recipient had incurred them.  If the recipient dies, donor expenses actually  
incurred after death  of the recipient will be  treated as incurred before the death  of the 
recipient.   
43 NHIC, Corp. (J14 A/B MAC), Modifier Billing  Guide, June 2011, p. 9.  Modifier QL  
indicates that the patient was pronounced dead after the ambulance was called and that 
the ambulance base rate should be paid with no mileage adjustment or rural adjustment. 
44 NHIC, Corp., Evaluation and Management Services Billing Guide, March 2011, p. 17.   
Discharge services are billed using procedure codes 99238 and 99239 for hospital 
settings and 99315 and  99316 for nursing facility settings.  In  other settings, a brief 
evaluation and management service code is  used; however, we did not consider  
evaluation and management service codes to be discharge codes for our analysis.  The  
five  character codes and descriptions included in this study are obtained from  
Current Procedural Terminology (CPT), copyright 2012 by the  American Medical  
Association (AMA).  CPT is developed by the AMA  as a listing of descriptive terms  
and five character identifying codes and  modifiers for reporting medical services 
and procedures.   Any use of CPT outside  of this study should refer to the most  
current version of the Current Procedural Terminology available from AMA.  
Applicable FARS/DFARS apply.  
45 NHIC, Corp., Evaluation and Management Services Billing Guide, March 2011, p. 25.   
Reasonable and necessary medical services rendered up to and including pronouncement  
of death by a physician are covered diagnostic and therapeutic services.   
46 Interpretation of tests is allowable after a beneficiarys death when the physician could 
not  have known that the beneficiary had died.  To account  for these instances, we 
searched procedure code descriptions using the phrase interpretation and report only.  
47 CMS, Medicare Claims Processing Manual, Pub. 100-04, ch.  20,    30.5.4.   
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   10 
   
   
Parts C and D. We analyzed monthly payments to Medicare Advantage 
organizations and prescription drug plan sponsors to identify those made 
after the beneficiaries months of death.  For Part C and D payments for 
which the beneficiaries months of death preceded the monthly payment, 
we summed payment amounts to calculate the overall amount that 
Medicare inappropriately paid on behalf of these deceased beneficiaries.  
We also analyzed Part C and D payments made on behalf of deceased 
beneficiaries by Medicare Advantage organization and prescription drug 
plan sponsor. 
Identifying deceased beneficiaries with improper payments across 
Medicare. We identified deceased beneficiaries for whom improper 
payments were made across Medicare.  We identified deceased 
beneficiaries with Part A and B payments after their deaths.  In addition, 
we identified deceased beneficiaries with Part A and B payments after 
their deaths that had also Part D payments.  We identified deceased 
beneficiaries for whom both Part C and D payments were made after their 
months of death. 
Identifying Providers and Suppliers With High Numbers of Paid 
and/or Unpaid Part B Claims With Service Dates After 
Beneficiaries Deaths 
Separately, we analyzed paid and unpaid Part B claims for physician and 
nonphysician services and DMEPOS items for deceased beneficiaries to 
identify providers and suppliers that submitted claims with service dates 
after beneficiaries deaths in 2011.48  In total, we identified 245,559 such 
claims submitted by 39,082 providers and 8,556 suppliers.  
Ninety-eight percent (239,598) of claims were not paid by Medicare and 
were submitted by 37,550 providers and 8,543 suppliers.  The remaining 
2 percent (5,961) of these claims  were paid by Medicare and were 
submitted by 2,468 providers and 254 suppliers.  About 3 percent (1,177) 
of providers and suppliers had both paid and unpaid claims with service 
dates after beneficiaries deaths.  
For each provider, we calculated the total number of paid and unpaid 
Part B claims with service dates after beneficiaries deaths.  Similarly, for 
each supplier, we calculated the total number of paid and unpaid Part B 
claims with service dates at least 30 days after beneficiaries deaths.  We  
also calculated, for each provider and supplier, the total number of 
deceased beneficiaries associated with paid and unpaid Part B claims.   
 
48  We  did not conduct this analysis on Part A because there were few unpaid claims with 
service dates after beneficiaries deaths  and a small  number of Part A providers that  
submitted both paid and unpaid claims.  Because of programmatic differences, this 
analysis could not  be applied to Parts C and  D.  
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   11 
   
   
Providers and suppliers with a high number of paid and/or unpaid Part B 
claims for deceased beneficiaries raise concerns, especially if their billing  
for deceased beneficiaries represents a substantial proportion of their 
overall Medicare billing.  To determine how the billing for deceased 
beneficiaries compared to providers and suppliers overall Medicare 
billing, we analyzed all Part B claims submitted in 2011 by providers and 
suppliers associated with the most paid and/or unpaid claims with service 
dates after beneficiaries deaths.       
Geographic Analysis  
For Part A and B claims with service dates after beneficiaries deaths, we 
identified the Core Based Statistical Areas (CBSAs) in which providers or 
suppliers were located using their business address ZIP Codes.49   We  
identified CBSAs with the most Part A and B payments made on behalf of 
deceased beneficiaries.50   We also identified CBSAs with providers and/or  
suppliers with the most paid or unpaid Part B claims with service dates 
after beneficiaries deaths.   
Limitations 
We did not independently verify the accuracy of CMSs date-of-death 
information when it matched that in SSAs Death Master File.  
Standards 
This study was conducted in accordance with the Quality Standards for 
Inspection and Evaluation issued by the Council of the Inspectors General 
on Integrity and Efficiency.   
 
49 United States Census Bureau, Metropolitan and Micropolitan, May 2012.  Accessed at 
http://www.census.gov/population/metro/  on December 20, 2012.  CBSAs are both 
metropolitan and micropolitan areas as defined by the Office of Management and Budget.  
A metropolitan area contains  a core urban area of 50,000  or more in  population, and a 
micropolitan area contains an  urban core of at least 10,000 (but less than  50,000) in 
population.    
50  We  did not conduct a geographic analysis of Part C and D  payments  made on  behalf  of 
deceased  beneficiaries because the geographic coverage of plans offered by Medicare 
Advantage organizations and prescription drug plan sponsors varies.  Some plans are  
localized  on the level of a county or region  within a State, whereas other plans can cover 
multiple States or be  nationwide. 
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   12 
   
   
FINDINGS 
CMS has safeguards to prevent and recover Medicare 
payments made on behalf of deceased beneficiaries; 
however, it inappropriately  paid $23 million in 2011 
after beneficiaries deaths  
CMS inappropriately paid less than one-tenth of a percent ($23 million) of  
total Medicare expenditures in 2011 to providers, suppliers, Medicare 
Advantage organizations, and prescription drug plan sponsors on behalf of 
beneficiaries who died in 2009, 2010, or 2011.  CMS has safeguards to 
prevent and recover Medicare payments made on behalf of deceased 
beneficiaries. For Parts A and B, CMS implemented a process in April 
2011 to prevent improper payments for services and items billed after 
beneficiaries deaths.  For Parts C and D, CMS automatically disenrolls an  
individual from a Medicare Advantage plan or prescription drug plan upon 
his or her death. These safeguards, however, did not prevent all improper 
payments.     
Part C accounted for the most improper payments ($20 million) in 2011.  
Part A had the highest average payment per deceased beneficiary ($8,468).  
Table 2 shows total and average improper payments per deceased 
beneficiary by Part of Medicare. Appendix A shows improper payments 
made on behalf of deceased beneficiaries by Part of Medicare and year of 
beneficiary death from 2009 to 2011. 
Table 2: Medicare Payments After Beneficiaries Deaths by Part of 
Medicare, 2011  
Average 
Medicare 
Number of  Medicare 
Part of  Payments After  
Description   Deceased   Payment for 
Medicare   Beneficiaries 
Beneficiaries*   Deceased  
Deaths  
Beneficiary  
Offers the option to enroll in and receive care from 
Part C  $19,906,805  11,835   $1,682  
private Medicare Advantage plans  
Part D  Offers subsidized access to drug insurance coverage  $1,049,444  5,101  $206 
Helps pay for hospital, home health, skilled nursing 
Part A  $1,634,280  193   $8,468  
facility, and hospice care  
Helps pay for physician and nonphysician services, 
Part B  $592,823  1,541   $385 
including DMEPOS items 
     Total  $23,183,352   17,403   $1,332  
*Column sum exceeds total  because some deceased beneficiaries had payments in multiple parts of Medicare. 
Source:  OIG analysis of Part A and Part B claims data and Part C and D payments from the MARx system, 2013. 
Of the 17,403 deceased beneficiaries associated with improper Medicare 
payments in 2011, 58 percent (10,025) had less than $1,000 in improper 
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   13 
   
   
Medicare payments after their deaths.  However, 12 deceased beneficiaries  
had over $50,000 each in improper Medicare payments after their deaths.  
Of these, Medicare paid over $100,000 each for two beneficiaries that died 
in 2009 and 2010. These two beneficiaries accounted for $256,689 in 
improper Part A, B, and D payments in 2011.  
Medicare Parts C and D accounted for 90 percent of improper 
payments in 2011 made on behalf of deceased beneficiaries  
Medicare Parts C and D accounted for $21 million of the $23 million 
(90 percent) in improper payments after beneficiaries deaths in 2011.  
CMS initially paid $610 million to Medicare Advantage organizations and 
prescription drug plan sponsors on behalf of deceased beneficiaries. 
However, it retroactively recovered 97 percent ($589 million) of these 
payments.  At the time of our review, CMS had not recovered the 
remaining 3 percent ($21 million) inappropriately paid on behalf of 15,838 
deceased beneficiaries.  About 7 percent (1,098) of deceased beneficiaries 
were associated with both improper Part C and D payments in 2011. 
Nearly 86 percent ($20 million) of improper Medicare payments made on 
behalf of deceased beneficiaries were made to 514 Medicare Advantage 
organizations.  Fifteen organizations accounted for 31 percent 
($6.2 million) of improper Part C payments after beneficiaries deaths in 
2011.  Specifically, Medicare paid $1.1 million to 1 organization on behalf  
of 592 deceased beneficiaries. This organization received the most 
improper payments on behalf of the most deceased beneficiaries of all 
Medicare Advantage organizations in 2011.  Nearly all (11,767 of 11,835) 
deceased beneficiaries who were associated with improper Part C 
payments in 2011 also died in 2011.   
Approximately $1 million in improper Medicare payments made on behalf  
of deceased beneficiaries were made to 398 prescription drug plan 
sponsors. Twelve sponsors accounted for 70 percent ($735,224) of 
improper Part D payments after beneficiaries deaths in 2011.  
Specifically, Medicare paid $162,880 to 1 sponsor on behalf of 
465 deceased beneficiaries and $140,505 to another sponsor on behalf of 
758 beneficiaries. These two sponsors had the most improper payments 
on behalf of the most deceased beneficiaries of all prescription drug plans 
in 2011.  Thirty-nine percent of improper Part D payments were made on 
behalf of beneficiaries who died in 2010. 
   
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   14 
   
   
Medicare Parts A and B accounted for 10 percent of improper 
payments in 2011 made on behalf of deceased beneficiaries  
Medicare Parts A and B accounted for $2 million of the $23 million 
(10 percent) in improper payments after beneficiaries deaths.  CMS 
inappropriately paid approximately $2.2 million in 2011 for Part A and B 
claims with service dates after the deaths of 1,626 beneficiaries.  About 
7 percent (108) of these were associated with both Part A and B payments 
in 2011.  Additionally, 26 of the 108 beneficiaries who had both Part A  
and B payments after their deaths also had Part D payments.   
Seventy-five percent ($1.7 million) of improper Part A and B payments 
were made on behalf of beneficiaries who died before the effective date of  
the informational unsolicited response process, which CMS developed to 
identify and prevent payment for Part  A and B services after beneficiaries  
dates of death. However, 25 percent ($560,440) of these improper 
payments were associated with 378 beneficiaries who died after the 
effective date of this process.   
Claims for Part A services had service dates an average of 216 days after 
beneficiaries deaths.  For Part B, claims for physician and nonphysician 
services had service dates an average of 158 days after beneficiaries  
deaths, and claims for DMEPOS items had service dates an average of 
119 days after beneficiaries deaths.  Certain procedure codes and 
modifiers were associated with a high number of Part B claims with 
service dates after beneficiaries deaths.  For example, 80 percent of 
DMEPOS items associated with deceased beneficiaries were rental items  
(e.g., oxygen concentrators, nebulizers, wheelchairs), indicated by 
modifier RR. Appendix B provides information on these procedure codes 
and modifiers for Part B claims.       
In 2011, 10 CBSAs accounted for 50 percent ($1.1 million of $2.2 million)  
of Part A and B payments for claims with service dates after beneficiaries  
deaths. Table 3 shows the improper Medicare payments, the number of 
deceased beneficiaries, and the number of Part A or B providers and 
suppliers as broken down by these 10 CBSAs. New York City had the 
most improper Part A and B payments made on behalf of deceased 
beneficiaries (nearly $200,000) and the most deceased beneficiaries for 
whom services were billed (142 of 1,626) in 2011.  Overall, Part A and B 
providers and suppliers billed for deceased beneficiaries in 376 of 
955 CBSAs.    
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   15 
   
   
Table 3: Part A and B Payments After  Beneficiaries Deaths by CBSA, 2011  
Medicare  Number of  Number of 
Number 
CBSA   Payment  Deceased   Providers/ 
of Claims  
Amount  Beneficiaries   Suppliers  
New York City, NY  $192,476   142   354   226  
Indianapolis, IN  $150,330   12   287   103  
Philadelphia, PA  $140,523  61   334   135  
Boston, MA  $127,430   47   189   99  
St. Louis, MO  $116,408   14   128   53  
Providence, RI   $102,687   13   189   35  
Baton Rouge, LA  $100,563   8  146   67  
Chicago, IL   $69,590   93   229   123  
Houston, TX   $62,978   42   132   60  
Jackson, MS   $58,927   9  40   19 
     Total  $1,121,912    431*  2,028   920  
Note: The remaining 366 CBSAs accounted for $1.1 million. 

*Column sum exceeds total  because some deceased beneficiaries were associated with providers/suppliers
  
in different CBSAs. 

Source:  OIG analysis of Part A and Part B claims data, 2013. 

 
Eleven percent of improper Medicare payments made 
on behalf of deceased beneficiaries resulted from 
missing or incorrect dates of death  
Eighty-eight percent of improper Medicare payments made on behalf of 
deceased beneficiaries in 2011 were associated with beneficiaries who had 
matching dates of death in CMSs Enrollment Database and SSAs Death 
Master File. However, 11 percent ($2.6 million of $23 million) of 
improper payments were attributable to missing or incorrect dates of death 
in CMSs Enrollment Database in 2011.51   
When beneficiaries dates of death in CMSs Enrollment Database and 
SSAs Death Master File did not match, we used Accurint to independently 
confirm whether beneficiaries were deceased and the dates on which they 
had died. Dates of death in CMSs Enrollment Database were inaccurate 
largely because:  
 
51 The remaining 1 percent  of improper Medicare payments were associated with 
deceased beneficiaries who had default dates  of death in CMSs Enrollment Database but 
who had Medicare payments after their dates of  death as listed in Accurint. 
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   16 
   
   
1. 	  no date of death was listed for a deceased beneficiary, or   
2. 	  the date of death was incorrect; however, CMS considered it 
verified (i.e., CMSs Enrollment Database contained a specific day 
of death instead of a default date of death).  
CMS did not have dates of death for 375 deceased 
beneficiaries, resulting in $2.5 million in improper Medicare 
payments 
Of the 17,403 deceased beneficiaries associated with improper Medicare 
payments after their deaths, CMS did not have dates of death for 
375 beneficiaries who died before or during 2011.  As a result, CMS made 
$2.5 million in improper payments.  For almost all (374 of 375) of these 
deceased beneficiaries, the SSA Death Master File contained the correct 
dates of death. However, no dates of death were in CMSs Enrollment 
Database. 
Conversely, CMSs Enrollment Database correctly did not list dates of 
death for 401 living beneficiaries even though they had dates of death in 
SSAs Death Master File.  For 88 of the 401 beneficiaries, the incorrect 
dates of death listed in SSAs Death Master File were those of spouses or 
relatives. Additionally, 17 beneficiaries died in 2012 but were incorrectly 
listed in SSAs Death Master File as having died between 2009 and 2011.   
CMS had incorrect dates of death for 105 deceased 
beneficiaries, resulting in $84,500 in improper Medicare 
payments 
For 105 deceased beneficiaries, CMS inappropriately paid $84,519 in 
2011 because the verified dates of death were incorrect.  When CMS 
receives a report of a specific day of death, it considers the date of death 
entered into CMSs Enrollment Database to be verified.  For 99 percent 
(104 of 105) of these beneficiaries with incorrect dates of death in the 
Enrollment Database, SSAs Death Master File contained the correct dates 
of death. 
On average, incorrect verified dates of death in CMSs Enrollment 
Database were incorrect by 105 days.  Seventeen percent (18 of 105) of 
incorrect verified dates of death were incorrect by exactly 1 year 
(365 days). Nearly 29 percent (30 of 105) of incorrect verified dates of 
death were incorrect by 1 month (30 or 31 days), and 7 percent (7 of 105) 
were incorrect by 1 day.  
 
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   17 
   
   
In 2011, 251 providers and suppliers had high 
numbers of paid and/or unpaid Part B claims with 
service dates after Medicare beneficiaries deaths 
Most providers and suppliers with Part B claims with service dates after 
beneficiaries deaths had 1 paid or unpaid claim in 2011; however, 
251 providers and suppliers had a high number of paid claims and/or 
unpaid claims with service dates after beneficiaries dates of death.  
Four providers had high numbers of both paid and unpaid Part B claims  
with service dates after beneficiaries deaths.  Even though most Part B 
claims with service dates after beneficiaries deathsin particular those 
for DMEPOS itemswere not paid by Medicare, providers and suppliers 
with high numbers of unpaid claims may be attempting to obtain payment 
for services that were not provided. Providers and suppliers with high 
numbers of paid and/or unpaid Part B claims with service dates after 
beneficiaries dates of death may indicate fraud, waste, or abuse.     
Sixty-five providers and suppliers had 10 or more paid Part B 
claims with service dates after beneficiaries deaths in 2011 
Of the 2,722 providers and suppliers associated with paid claims with 
service dates after beneficiaries deaths, 61 providers and 4 suppliers had 
10 or more of these claims in 2011.  Medicare inappropriately paid these 
providers and suppliers $101,068. Fourteen of these 65 providers and 
suppliers were located in Los Angeles, Philadelphia, or Springfield 
(Illinois). Six providers had over 50 paid Part B claims associated with 
deceased beneficiaries; 1 provider had 116 paid claims with service dates 
after beneficiaries dates of death.  Medicare inappropriately paid this 
provider $5,224 in 2011 for Part B services provided to deceased 
beneficiaries. Ninety-eight percent (2,657) of providers and suppliers with 
paid claims with service dates after beneficiaries deaths had fewer than 
10 such claims; most had 1 paid claim with a service date after the 
beneficiarys date of death.   
In 2011, 190 providers and suppliers had over 100 unpaid 
Part B claims with service dates after beneficiaries deaths 
Of the 46,093 providers and suppliers associated with unpaid claims for 
deceased beneficiaries in 2011, 190 had over 100 unpaid Part B claims  
with service dates after beneficiaries  dates of death; 75 percent (143) were 
suppliers. Of these providers and suppliers, one-fourth (48 of 190) were 
located in New York City, Los Angeles, or Miami.  These CBSAs align 
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   18 
   
   
with geographic areas where Federal investigators and analysts have 
historically focused efforts to combat Medicare fraud, waste, and abuse.52    
Fourteen providers and suppliers had over 500 unpaid Part B claims with 
service dates after beneficiaries  deaths; 1 supplier had 2,288 of these 
unpaid claims.  Thirty percent of the claims submitted in 2011 by this 
supplier were not paid. Additionally, unpaid claims for deceased 
beneficiaries represented nearly 6 percent of this suppliers total unpaid 
claims in 2011.  Table 4 shows the number of providers and suppliers by 
number of unpaid Part B claims with service dates after beneficiaries  
deaths.  
Table 4: Providers and Suppliers by  Number of Unpaid Part B Claims With 
Service Dates After Beneficiaries Deaths, 2011  
Number of Unpaid  
Number of  Number of 
Part B Claims With Service Dates 
Providers  Suppliers   
After Beneficiaries Deaths   
1100  37,503   8,400  
101200  32   98  
201300  5  23  
301400  5  10  
401500  2  1 
501600  2  5 
601700  1  3 
701800  0  2 
2,288*  0  1 
     Total  37,550   8,543  
 
*One supplier had  over 800 unpaid Part B claims with service dates after beneficiaries deaths.
 
Source:  OIG analysis of  Part B claims data, 2013. 

 
Seventy of these 190 providers and suppliers had over 100 unpaid Part B 
claims for over 50 deceased beneficiaries.  Thirteen suppliers had unpaid 
Part B claims for over 100 deceased beneficiaries, and 2 of these suppliers 
had unpaid claims associated with more than 400 deceased beneficiaries.  
For one of these two suppliers, 7 percent of the beneficiaries for whom it 
had unpaid claims were deceased.  Nearly 4 percent of total beneficiaries 
for whom the same supplier had paid or unpaid claims in 2011 were 
deceased.    
 
52 Two of these three CBSAsLos Angeles and Miamiare among the nine cities 
targeted by the Medicare Strike Force.  The third CBSANew York Cityincludes 
Brooklyn, another city where the Strike Force operates.  The Strike Force is part of 
HEAT (the  Health Care Fraud Prevention and Enforcement Action Team), a joint effort 
of HHS and the Department of Justice, to  prevent,  deter, and aggressively prosecute 
health care fraud.  
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   19 
   
   
CONCLUSION AND RECOMMENDATIONS 
Prior OIG studies and audit reports have identified improper Medicare 
payments after beneficiaries deaths.  Consequently, CMS implemented 
safeguards to address this vulnerability.   These safeguards appear to have 
prevented or recovered most Medicare payments made on behalf of 
deceased beneficiaries; however, they did not prevent all improper 
payments.  In this review, we found that CMS inappropriately paid 
$23 million (less than one-tenth of a percent of total Medicare 
expenditures) in 2011 after beneficiaries deaths.  Part C accounted for 
86 percent of these improper payments.  Additionally, 11 percent of the 
$23 million in improper payments made on behalf of deceased 
beneficiaries resulted from missing and incorrect dates of death.     
Health care fraud schemes have involved providers or suppliers submitting 
fraudulent claims to Medicare, including claims for deceased 
beneficiaries. We identified 251 providers and suppliers that had high 
numbers of paid and/or unpaid Part B claims with service dates after 
beneficiaries deaths.  These providers and suppliersin particular, those 
with a high number of unpaid Part B claimswere located primarily in 
geographic areas historically known for health care fraud.  Although most 
claims with service dates after beneficiaries deaths submitted by these 
providers and suppliers were not paid by Medicare, these providers and 
suppliers may be attempting to obtain payment for services that were not 
provided and warrant further scrutiny.         
We recommend that CMS: 
Improve Existing Safeguards To Prevent Future Improper 
Medicare Payments After Beneficiaries Deaths 
CMS should determine why its existing safeguards did not prevent all 
improper payments made on behalf of deceased beneficiaries with dates of  
death in its Enrollment Database.  Although CMS has made progress in 
preventing and recovering improper Medicare payments associated with 
deceased beneficiaries through the informational unsolicited response 
process in Parts A and B and through automatic disenrollment in Parts C 
and D, it made approximately $23 million in improper payments in 2011 
after beneficiaries deaths.  Eighty-eight percent of these improper 
payments were associated with beneficiaries who had matching dates of 
death in CMSs Enrollment Database and SSAs Death Master File.  CMS  
should address any issues it identifies and improve existing safeguards to 
prevent future improper Medicare payments after beneficiaries deaths.  
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   20 
   
   
Take Appropriate Action on Improper Medicare Payments 
Made on Behalf of Deceased Beneficiaries and Correct 
Inaccurate Dates of Death  
In a separate memorandum, we will refer to CMS for appropriate action 
information associated with the approximately $23 million in improper 
Medicare payments made on behalf of deceased beneficiaries identified in  
this report. CMS should recover these improper payments, as appropriate.  
Additionally, we will refer to CMS information on the 480 deceased 
beneficiaries with missing or incorrect dates of death identified in this 
report. CMS should correct these inaccurate dates in its Enrollment 
Database. To fully prevent improper Medicare payments after 
beneficiaries deaths, CMS must have accurate beneficiary dates of death 
in its systems. CMS should also determine why dates of death were 
inaccurate for these deceased beneficiaries and resolve the issue.                      
Monitor Both Paid and Unpaid Part B Claims With Service 
Dates After Beneficiaries Deaths 
CMS should monitor both paid and unpaid Part B claims with service 
dates after Medicare beneficiaries deaths to identify providers and 
suppliers associated with high numbers of such claims.  These providers 
and suppliers may be attempting to obtain payment for services that were 
not provided. CMS could incorporate this analysis into its predictive 
analytic work and develop thresholds to identify providers and suppliers 
for further review.  For providers and suppliers that exceed these 
thresholds, CMS could initiate prepayment review of providers or 
suppliers claims and/or conduct site visits to ensure the legitimacy of 
these providers or suppliers.  
Take Appropriate Action on Providers and Suppliers That Had 
High Numbers of Paid and/or Unpaid Part B Claims With 
Service Dates After Beneficiaries Deaths 
In the aforementioned memorandum, we will also refer to CMS for 
appropriate action the 251 providers and suppliers we identified that had 
10 or more paid Part B claims and/or over 100 unpaid Part B claims with 
service dates after Medicare beneficiaries deaths.  Appropriate action may 
include: determining whether these providers and suppliers should be 
placed on prepayment review, conducting site visits, and/or referring them 
to benefit integrity contractors for further examination.   
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   21 
   
   
AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL  
RESPONSE 
CMS concurred with all four of our recommendations.  CMS is committed 
to preventing and recovering Medicare payments made on behalf of 
deceased beneficiaries.  For this reason, CMS has implemented safeguards 
to address this vulnerability and will improve its existing safeguards to 
prevent further Medicare payments after a beneficiarys death. 
With regard to our first recommendation, CMS concurred in principle and 
stated that it needs to analyze the details on the improper payments to 
determine whether there is an issue with the data and what aspects of its 
systems need to be modified.  We will send this information, as well as 
information regarding inaccurate dates of death, under separate cover.   
With regard to our second recommendation, upon receiving information 
on improper payments identified in this report, CMS will analyze each 
case to determine whether it can pursue recovery consistent with agency 
policies and procedures.  CMS will review the inaccurate dates of death 
identified in this report and work with SSA to make corrections, should 
they be required. 
With regard to our third recommendation, CMS is conducting analyses to 
determine whether it is feasible to build a model identifying providers 
submitting claims with dates of service that occurred after beneficiaries  
deaths. If this model is viable, CMS anticipates launching it into the 
Fraud Prevention System in the spring of 2014. 
With regard to our fourth recommendation, CMS will take appropriate 
action upon receiving information regarding providers and suppliers 
described in this report. Appropriate action may include conducting site 
visits, revalidations, or additional investigations, if warranted.  
Finally, CMS noted that it provided us with feedback on our use of SSAs  
Death Master File in its comments on a preliminary version of this report, 
stating that its accuracy is not guaranteed.  CMS further noted that the 
only official record of death information is SSAs Master Beneficiary 
Record, which sends information daily to the Enrollment Database.  In 
response to these preliminary comments, we clarified the difference 
between the Death Master File and the Master Beneficiary Record in the 
background of this report and indicated in the report that CMS receives its 
death information from the Master Beneficiary Record.  We did not 
recollect or reanalyze data to compare SSAs Death Master File to its 
Master Beneficiary Record. 
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   22 
   
   
We support CMSs efforts to address these issues and encourage continued 
progress. For the full text of CMSs comments, see Appendix C. 
   
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   23 
   
   
APPENDIX A 
Medicare Payments Made on Behalf of Deceased Beneficiaries 
by Year of Beneficiary Death 
 
Table A-1. Part A Payments for Services After Beneficiaries Deaths, 2011  
Type of  Year of   Number of 
Medicare  Number  Number of 
Part A   Beneficiary   Deceased  
Payments  of Claims   Providers 
Service  Death   Beneficiaries  
2009  $45,936  76  13   6 
2010  $16,154  65  31   22  
Outpatient  
2011   $46,012  158  105   92 
     Total  $108,116*   300*   141  121*  
 
2009  $125,693   12   4  3 
2010   $212,513  17  12   9 
Inpatient 
2011   $939,011  70  67   58 
     Total  $1,277,216**   99   79  70  
 
2009   $0  0  0  0 
Home  2010   $8,694  5  5  5 
Health   2011  $26,395  16  15   15 
     Total  $35,089   21   20   20  
 
2009   $0  0  0  0 
Skilled  2010  $76,815  11   6  6 
Nursing 
Facility  2011  $66,268  13   8  8 
     Total  $143,083   24   14   14  
 
2009   $0  0  0  0 
2010   $14,773  8  3  3 
Hospice  
2011  $56,001  32  29   29 
     Total  $70,774   40   32   32 
     Grand  Total   $1,634,280**   484   254  193  
* According  to Accurint, the date of death for one beneficiary  was in 2002.  This beneficiary and the payments associated 
 
with him or her are  included in the totals.  

** Column sum does not equal total because of rounding. 

Column sum exceeds total  because some providers and beneficiaries had multiple types of Part A services. 

Source:  Office of  Inspector General (OIG) analysis of Part A claims data, 2013. 

 
 
   
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   24 
   
   
APPENDIX A  (CONTINUED)  
 
Table A-2. Part B Payments for Services and Items After Beneficiaries 
Deaths, 2011  
Year of   Number of  Number of 
Type of   Medicare  Number of 
Beneficiary   Providers/  Deceased  
Part B Service  Payments  Claims  
Death   Suppliers   Beneficiaries  
 
2009   $59,834  610  162   11  
Physician and   2010  $77,200   1,242   320   66  
Nonphysician   
Services   2011   $411,139  3,535  2,065   1,219 
     Total  $548,368*   5,390*   2,468  1,297*  
2009  $1,044   19   4  4 
Durable Medical  2010   $26,637  324  141   131  
Equipment, Prosthetics, 
Orthotics, and Supplies   2011   $16,773  228  130   123 
     Total  $44,454   571   254  258 
     Grand  Total   $592,823   5,961   2,722   1,541  
*According to Accurint, the date of death for one beneficiary  was in 2002.  This beneficiary and the payments associated with him or her 
are included in the totals. 
Column sum exceeds total because some beneficiaries had multiple types of Part B  services. 
Source:  OIG analysis of  Part B claims data, 2013. 
 
Table A-3. Part C and D Payments on Behalf of Deceased Beneficiaries, 
2011  
Year of   Number of 
Part of  Medicare  Number of 
Beneficiary   Deceased  
Medicare   Payments  Contracts*  
Death   Beneficiaries  
 
2009  $62,338   12   13  
2010  $753,379   47   55  
Part C 
2011  $19,091,087   514   11,767 
     Total  $19,906,805**  514  11,835  
 
2009  $79,742   27   67  
2010  $403,424   64   172  
Part D 
2011  $564,632   393   4,861 
     Total  $1,049,444***   398  5,101*** 
     Grand  Total   $20,956,249  576  15,838  
* For Part C,  the term contracts refers to Medicare Advantage organizations.  For Part D, the term 
 
contracts refers to prescription drug plan sponsors. 

** Column sum does not equal total because of rounding. 

*** According to Accurint, the date of death for one beneficiary was in 2002.  This beneficiary and the 

payments associated with him or her are included in the totals. 

Column sum exceeds total because some contracts and  beneficiaries had both Part C and D  

payments. 

Source:  OIG analysis of Part C and D  payments from the MARx system, 2013. 

Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   25 
   
   
APPENDIX B 
Procedure Codes and Modifiers on Medicare Part B Claims With Service Dates After Beneficiaries 
Deaths 
Table B-1. Procedure Codes on Part B Claims for Physician and Nonphysician Services With Service Dates After 
Beneficiaries Deaths, 2011  
Number of  Average Day  Count 
Procedure   Number of  Number of 
Description  Deceased   Between Date of Death  
Code   Claims   Providers 
Beneficiaries   and Service Date  
99232*   Subsequent hospital care/day 25 minutes  587  246   372  59  
99233   Subsequent hospital care/day 35 minutes  354  178   241  37  
71010   Radiologic examination, chest; single view, frontal   340  135   235  85  
99291   Critical  care ill/injured patient init 30-74 min   236  120   160  37  
99231   Subsequent hospital care/day 15 minutes  151  99   116  19  
A0425  Ground mileage, per statute mile   129  82   88  114  
99223   Initial hospital care/day 70 minutes   120  85   115  84  
36415   Collection of venous blood by  venipuncture   117  47   49  345  
93010   Electrocardiogram report  114  30   63  403 
     Total      2,148   651  1,273  --
Note: The remaining 566 procedure  codes on deceased  beneficiaries Part  B claims for physician and nonphysician services were each on  fewer than 100 claims. 

*The five character codes and descriptions included in this study are obtained from Current Procedural Terminology (CPT), 

copyright 2012 by the American Medical Association (AMA). CPT is developed by the AMA  as a listing of  descriptive terms and 
 
five  character identifying codes and modifiers for reporting medical services and procedures.  Any use of CPT outside of this 
 
study should refer to the most current version of the Current Procedural Terminology available  from AMA.  Applicable
  
FARS/DFARS apply.
 
Column sum exceeds total  because some providers and beneficiaries were associated with multiple procedure  codes. 
Source:  Office of  Inspector General (OIG) analysis of Part B claims data, 2013. 
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   26 
   
   
APPENDIX B (CONTINUED)  
 
Table B-2. Modifiers on Part B Claims for Physician and Nonphysician Services With Service Dates After Beneficiaries 
Deaths, 2011  
Number of 
Number of  Number of 
Modifier  Description   Deceased  
Claims   Providers 
Beneficiaries  
26   Professional component  834  252   531  
GC  Resident/teaching physician service   146  57   97  
Significant, separately identifiable evaluation and management service by  
25   134  74   95  
the same physician on the same day of  the procedure or other service  
59   Distinct procedural service  134  50   58  
GP  Services delivered under an outpatient physical therapy plan of  care   116  4  4 
    Total   1,296  319  709  
Note: The remaining 65 modifiers on  deceased beneficiaries Part  B claims  for physician and nonphysician services were each listed  fewer than 100  times. 
Column sum exceeds total because some providers, beneficiaries, and claims were associated with multiple modifiers.  
Source:  OIG analysis of  Part B claims data, 2013. 
   
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   27 
   
   
APPENDIX B (CONTINUED)  
 
Table B-3. Procedure Codes on Part B Claims for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies With 
Service Dates At Least 30 Days After Beneficiaries Deaths, 2011  
Number of  Average Day  Count 
Procedure   Number of  Number of 
Description  Deceased   Between Date of Death  
Code   Claims   Suppliers 
Beneficiaries   and Service Date  
E0570  Nebulizer, with compressor   84  67   65  73  
Oxygen concentrator, single delivery port, capable of delivering 
E1390  85 percent or greater oxygen concentration at the prescribed  78  51   50  120  
flow rate  
K0001  Standard wheelchair  54  39   37  60  
Hospital bed, semi-electric (head and foot adjustments), with 
E0260  45  29   28  97  
any type side rails, with mattress 
Portable gaseous oxygen system, rental; includes portable 
E0431  container, regulator, flowmeter, humidifier, cannula or mask, and   37  21   21  132  
tubing  
Elevating leg rests, pair (for use with capped rental wheelchair 
K0195  34  20   20  74  
base)  
K0003  Lightweight wheelchair  24  15   15  65  
K0004  High strength, lightweight wheelchair   23  13   13  97  
Blood glucose test or reagent strips for home blood glucose 
A4253  22  9  8  330  
monitor, per 50  strips 
A4259  Lancets, per box of 100   21  8  7  320 
     Total      422   209  206  --
Note: The remaining 52 procedure  codes on deceased beneficiaries Part B  claims for durable  medical equipment, prosthetics, orthotics, and suppliers (DMEPOS) were each on  
  
fewer than 20 claims. 
Column sum exceeds total because some suppliers and beneficiaries were associated with multiple procedure  codes. 
Source:  OIG analysis of  Part B claims data, 2013. 
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   28 
   
   
APPENDIX B (CONTINUED)  
 
Table B-4. Modifiers on Part B Claims for DMEPOS Items With Service Dates At Least 30 Days  After Beneficiaries 
Deaths, 2011  
Number of 
Number of  Number of 
Modifier  Description   Deceased  
Claims   Suppliers  
Beneficiaries  
RR   Rental   459  223   214  
KX  Documentation on file  332  145   140  
DMEPOS item, parenteral enteral nutrition (PEN) pump or capped rental, 
KJ  295  156   151  
4th to 15th months  
6-month maintenance and servicing fee for reasonable and necessary  
MS  parts and labor that are not covered under any manufacturer or supplier   31  26   26  
warranty 
KI  DMEPOS item, second or third month rental   30  25   25 
     Total   544  253  247  
Note: The remaining 17 modifiers on  deceased beneficiaries Part  B claims  for DMEPOS items were each listed fewer than 30  times. 
Column sum exceeds total because some suppliers, beneficiaries, and claims were associated with multiple modifiers.  
Source:  OIG analysis of  Part B claims data, 2013. 
   
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   29 
  APPENDIXC 
Agency Comments 
(/. ,,..:,..V!Ift,{.,._..-
DEPARTMENT OF HEALTH & HUMAN SERVICES  Centers for Me<llcare & Me<ltcald SeNioes 
Offic of the Administrator 
Washington, DC 20201 
DATE:  AUG 30  2013 
TO:  Daniel R. Levinson 
Inspector General 
FROM:  Marilyn Tavenner 
Administrator 
SUBJECT: 	 Office of Inspector General (OIG) Draft Report--"CMS Prevented or Recovered 
Most Medicare Payments Made on Behalf of Deceased Beneficiaries in 20 II'' 
(OEJ-04-12-00 130) 
The Centers for Medicare & Medicaid Services (CMS) appreciates the opportunity to review and 
comme nt on the above-referenced OIG draft report. The purpose of this report is to identify and 
describe Medicare payments made on behalf ofdeceased beneficiaries, determine the accuracy 
ofCMS' information on beneficiaries' dates of death, and identify providt.'l'S and suppliers with 
paid or unpaid Part B claims with service dates after beneficiaries' deaths. 
The CMS is committed to preventing or recovering Medicare payments made on behalf of 
deceased beneficiaries. CMS has implemented safeguards to address this vulnerability.  For 
example. CMS put into place an infomJational unsolicited response process for Parts A and B to 
prevent improper payments for services and items billed after a beneficiary's death. This process 
reviews all Part A and B claims approved for payment in the claims history and identifies claims 
with service dates up to 3 years after the beneficiary's date of death. For Parts C and D. CMS 
instituted a system to automatically disenroll an individual from a Medicare Advantage plan or 
prescription drug plan upon the beneficiary's death.  In 2011, CMS retroactively recovered 99 
percent of improper Part C and D payments associated with deceased beneficiaries. CMS is 
committed to working to improve its cxi~-ting safeguards to prevent further Medicare payments 
made after a beneficiary s death. 
We appreciate OIG's efforts in working with CMS to ensure that appropriate action is taken to 
address Medicare payments made after a beneficiary's death including improving existing 
safeguards and monitoring claims with service dates after a beneficiary's death. Our response to 
each of the OIG recommendations is as follows. 
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)  30   
   
APPENDIX C (CONTINUED)
  
 
 
   
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   31 
   
   
APPENDIX C (CONTINUED)
  
 
 
   
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   32 
   
   
ACKNOWLEDGMENTS 
This report was prepared under the direction of Dwayne Grant, Regional 
Inspector General for Evaluation and Inspections in the Atlanta regional 
office, and Jaime Durley, Deputy Regional Inspector General.  
Rachel Bessette served as the lead analyst for this study.  Other Office of 
Evaluation and Inspections staff from the Atlanta regional office who 
conducted this study include Scott Horning.  Central office staff who 
provided support include Althea Hosein, Scott Manley, and 
Christine Moritz.   
Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011 (OEI-04-12-00130)   33 
   
Office of Inspector General
http://oig.hhs.gov  
 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as  
amended, is  to protect the integrity of the Department of  Health and Human Services  
(HHS)  programs, as well as the health and welfare of beneficiaries  served by those 
programs.  This statutory mission  is  carried  out through  a nationwide network  of  audits, 
investigations, and inspections conducted by the  following operating components: 
Office of Audit Services 
The Office  of  Audit Services  (OAS) provides auditing services  for HHS, either by  conducting  
audits  with its own audit resources or by  overseeing  audit work done by others.  Audits  
examine the performance of HHS programs and/or its grantees and contractors in carrying  
out their respective responsibilities and are intended  to provide independent assessments of 
HHS programs and operations.  These assessments help reduce waste, abuse, and  
mismanagement and promote economy and efficiency  throughout  HHS. 
Office of Evaluation and Inspections 
The Office  of  Evaluation and Inspections (OEI)  conducts national evaluations to  provide 
HHS, Congress, and the public with timely, useful, and reliable information on significant 
issues.  These evaluations focus on preventing fraud,  waste, or abuse  and promoting  
economy, efficiency, and effectiveness of departmental programs.  To promote impact, OEI 
reports also present practical recommendations for improving program operations.  
Office of Investigations 
The Office of Investigations (OI) conducts criminal, civil, and administrative investigations  
of  fraud and misconduct  related to HHS programs, operations, and beneficiaries.  With 
investigators working in all 50 States and the District of Columbia, OI  utilizes its resources 
by actively  coordinating with the Department  of Justice  and other Federal, State, and local 
law enforcement authorities.  The investigative efforts of OI often lead to  criminal 
convictions, administrative sanctions,  and/or  civil monetary  penalties.  
Office of Counsel to the Inspector General 
The Office of Counsel to the  Inspector  General (OCIG) provides general legal services to 
OIG, rendering  advice and opinions on HHS programs and operations and  providing all  
legal support for OIGs  internal operations.  OCIG represents  OIG in all civil and 
administrative fraud and  abuse cases involving HHS programs, including False Claims Act, 
program exclusion, and civil monetary penalty cases.  In  connection with these cases, OCIG 
also negotiates and monitors corporate integrity agreements.  OCIG renders advisory 
opinions, issues compliance program  guidance, publishes fraud alerts, and provides other  
guidance  to  the health care industry concerning the anti-kickback statute and other  OIG  
enforcement authorities.