Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

MEDICARE PAYMENTS 

MADE ON BEHALF OF 

DECEASED BENEFICIARIES 

IN 2011 

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 beneficiary’s 

death. Therefore, payments for services provided after a beneficiary’s 

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 

Part of 

Medicare Description 2011 Medicare 

Expenditures 

Percentage of 

Total 2011 

Medicare 

Expenditures 

Part A Helps pay for hospital, home health, skilled 

nursing facility, and hospice care $188.3 billion 35% 

Part B 

Helps pay for physician outpatient hospital, home 

health, and other health services, including 

durable medical equipment, prosthetics, orthotics, 

and supplies (DMEPOS) 

$162.6 billion 30% 

Part C 

Offers beneficiaries the option to enroll in and 

receive care from private Medicare Advantage 

plans and certain other health insurance plans 

that contract with Medicare 

$123.7 billion 23% 

Part D 

Provides subsidized access to drug insurance 

coverage on a voluntary basis for all beneficiaries 

and premium and cost-sharing subsidies for 

low-income enrollees 

$66.7 billion 12%

 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-andEducation/Medicare-Learning-NetworkMLN/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/MedicareContracting/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 CMS’s 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 SSA’s Master Beneficiary 

Record and RRB’s 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 CMS’s 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) System’s 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 beneficiary’s 

date of death.23 

For example, if a beneficiary died on April 30, 2011, and the Common 

Working File system received notification of this beneficiary’s 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 response”—i.e., an automated 

notification—to claims processing contractors for these identified paid 

claims with service dates after a beneficiary’s date of death, and 

	 prevent any future improper payments for claims with service dates up 

to 3 years after the beneficiary’s 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 beneficiary’s 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 CMS’s 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. 

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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 SSA’s Death Master File, died 

between January 1, 2009, and December 31, 2011. We then used CMS’s 

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 CMS’s 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 CMS’s 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 SSA’s Death 

Master File to Medicare beneficiaries in CMS’s 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 zero—i.e., unpaid claims—we 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.” 

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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 SSA’s Death Master File 

and CMS’s Enrollment Database for each beneficiary. For instances in 

which SSA and CMS listed different dates of death, we used Accurint—a 

commercial data depository—to confirm whether these beneficiaries were 

deceased and the dates on which they died.40 When SSA and CMS dateof-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 beneficiary’s 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. Accurint’s primary source for dates of death is 

SSA’s 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). 

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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 beneficiary’s death,45 or were 

for interpretation of tests up to 10 days after the beneficiary’s 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 beneficiary’s 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 beneficiary’s 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 CMS’s date-of-death 

information when it matched that in SSA’s 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 

Part of 

Medicare Description 

Medicare 

Payments After 

Beneficiaries’ 

Deaths 

Number of 

Deceased 

Beneficiaries* 

Average 

Medicare 

Payment for 

Deceased 

Beneficiary 

Part C Offers the option to enroll in and receive care from 

private Medicare Advantage plans $19,906,805 11,835 $1,682 

Part D Offers subsidized access to drug insurance coverage $1,049,444 5,101 $206 

Part A Helps pay for hospital, home health, skilled nursing 

facility, and hospice care $1,634,280 193 $8,468 

Part B Helps pay for physician and nonphysician services, 

including DMEPOS items $592,823 1,541 $385

 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 

CBSA 

Medicare 

Payment 

Amount 

Number of 

Deceased 

Beneficiaries 

Number 

of Claims 

Number of 

Providers/ 

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 CMS’s Enrollment Database and SSA’s 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 CMS’s Enrollment Database in 2011.51 

When beneficiaries’ dates of death in CMS’s Enrollment Database and 

SSA’s 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 CMS’s 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 CMS’s 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., CMS’s 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 CMS’s Enrollment 

Database. 

Conversely, CMS’s Enrollment Database correctly did not list dates of 

death for 401 living beneficiaries even though they had dates of death in 

SSA’s Death Master File. For 88 of the 401 beneficiaries, the incorrect 

dates of death listed in SSA’s Death Master File were those of spouses or 

relatives. Additionally, 17 beneficiaries died in 2012 but were incorrectly 

listed in SSA’s 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 CMS’s Enrollment Database to be verified. For 99 percent 

(104 of 105) of these beneficiaries with incorrect dates of death in the 

Enrollment Database, SSA’s Death Master File contained the correct dates 

of death. 

On average, incorrect verified dates of death in CMS’s 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’ deaths—in particular those 

for DMEPOS items—were 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 

beneficiary’s 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 supplier’s 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 

Part B Claims With Service Dates 

After Beneficiaries’ Deaths 

Number of 

Providers 

Number of 

Suppliers 

1–100 37,503 8,400 

101–200 32 98 

201–300 5 23 

301–400 5 10 

401–500 2 1 

501–600 2 5 

601–700 1 3 

701–800 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 CBSAs—Los Angeles and Miami—are among the nine cities 

targeted by the Medicare Strike Force. The third CBSA—New York City—includes 

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 suppliers—in particular, those 

with a high number of unpaid Part B claims—were 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 CMS’s Enrollment Database and SSA’s 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 beneficiary’s 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 SSA’s 

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 SSA’s 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 SSA’s 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 CMS’s efforts to address these issues and encourage continued 

progress. For the full text of CMS’s 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 

Part A 

Service 

Year of 

Beneficiary 

Death 

Medicare 

Payments 

Number 

of Claims 

Number of 

Providers 

Number of 

Deceased 

Beneficiaries 

Outpatient 

2009 $45,936 76 13 6 

2010 $16,154 65 31 22 

2011 $46,012 158 105 92

 Total $108,116* 300* 141†

 121* 

Inpatient 

2009 $125,693 12 4 3 

2010 $212,513 17 12 9 

2011 $939,011 70 67 58

 Total $1,277,216** 99 79†

 70 

Home 

Health 

2009 $0 0 0 0 

2010 $8,694 5 5 5 

2011 $26,395 16 15 15

 Total $35,089 21 20 20 

Skilled 

Nursing 

Facility 

2009 $0 0 0 0 

2010 $76,815 11 6 6 

2011 $66,268 13 8 8 

 Total $143,083 24 14 14 

Hospice 

2009 $0 0 0 0 

2010 $14,773 8 3 3 

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 

Type of 

Part B Service 

Year of 

Beneficiary 

Death 

Medicare 

Payments 

Number of 

Claims 

Number of 

Providers/ 

Suppliers 

Number of 

Deceased 

Beneficiaries 

Physician and 

Nonphysician 

Services 

2009 $59,834 610 162 11 

2010 $77,200 1,242 320 66 

2011 $411,139 3,535 2,065 1,219

 Total $548,368* 5,390* 2,468† 1,297* 

Durable Medical 

Equipment, Prosthetics, 

Orthotics, and Supplies 

2009 $1,044 19 4 4 

2010 $26,637 324 141 131 

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 

Part of 

Medicare 

Year of 

Beneficiary 

Death 

Medicare 

Payments 

Number of 

Contracts* 

Number of 

Deceased 

Beneficiaries 

Part C 

2009 $62,338 12 13 

2010 $753,379 47 55 

2011 $19,091,087 514 11,767

 Total $19,906,805** 514† 11,835 

Part D 

2009 $79,742 27 67 

2010 $403,424 64 172 

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 AfteDeaths Table B-1. Procedure Codes on Part B Claims for Physician and Nonphysician Services With ServicBeneficiaries’ Deaths, 2011 

Procedure Code Description Number of Claims Number of Deceased Beneficiaries Number of Providers Avera

Between 

an

99232* Subsequent hospital care/day 25 minutes 587 246 372 

99233 Subsequent hospital care/day 35 minutes 354 178 241 71010 Radiologic examination, chest; single view, frontal 340 135 235 99291 Critical care ill/injured patient init 30-74 min 236 120 160 99231 Subsequent hospital care/day 15 minutes 151 99 116 A0425 Ground mileage, per statute mile 129 82 88 

99223 Initial hospital care/day 70 minutes 120 85 115 

36415 Collection of venous blood by venipuncture 117 47 49 

93010 Electrocardiogram report 114 30 63 

 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 claim*The five character codes and descriptions included in this study are obtained from Current Procedural Terminology copyright 2012 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive five character identifying codes and modifiers for reporting medical services and procedures. Any use of CPT outsidstudy should refer to the most current version of the Current Procedural Terminology available from AMA. ApplicabFARS/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 Deaths, 2011 

Modifier Description Number of Claims Number of Deceased Beneficiaries Num

Pro

26 Professional component 834 252 

GC Resident/teaching physician service 146 57 

25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service 134 74 59 Distinct procedural service 134 50 GP Services delivered under an outpatient physical therapy plan of care 116 4 

Total 1,296† 319† 

Note: The remaining 65 modifiers on deceased beneficiaries’ Part B claims for physician and nonphysician services were each listed fewer than 100 time†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, OrthotiService Dates At Least 30 Days After Beneficiaries’ Deaths, 2011 

Procedure Code Description Number of Claims Number of Deceased Beneficiaries Number of Suppliers Aver

Between 

an

E0570 Nebulizer, with compressor 84 67 65 

E1390 

Oxygen concentrator, single delivery port, capable of delivering 

85 percent or greater oxygen concentration at the prescribed 

flow rate 

78 51 50 

K0001 Standard wheelchair 54 39 37 E0260 Hospital bed, semi-electric (head and foot adjustments), with any type side rails, with mattress 45 29 28 E0431 

Portable gaseous oxygen system, rental; includes portable 

container, regulator, flowmeter, humidifier, cannula or mask, and 

tubing 

37 21 21 

K0195 Elevating leg rests, pair (for use with capped rental wheelchair base) 34 20 20 K0003 Lightweight wheelchair 24 15 15 K0004 High strength, lightweight wheelchair 23 13 13 A4253 Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips 22 9 8 A4259 Lancets, per box of 100 21 8 7 

 Total 422 209† 206† 

Note: The remaining 52 procedure codes on deceased beneficiaries’ Part B claims for durable medical equipment, prosthetics, orthotics, and suppliers (DMEPO

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 AfteDeaths, 2011 

Modifier Description Number of Claims Number of Deceased Beneficiaries Nu

Su

RR Rental 459 223 

KX Documentation on file 332 145 KJ DMEPOS item, parenteral enteral nutrition (PEN) pump or capped rental, 4th to 15th months 295 156 MS 

6-month maintenance and servicing fee for reasonable and necessary 

parts and labor that are not covered under any manufacturer or supplier 

warranty 

31 26 

KI DMEPOS item, second or third month rental 30 25 

 Total 544† 253† 

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 

,..,..VIft,. / ,._.. (.,:!{- DEPARTMENT OF HEALTH & HUMAN SERVICES 

DATE: AUG 3 0 2013 

TO: Daniel R. Levinson 

Inspector General 

FROM: Marilyn Tavenner 

Administrator 

Centers for Me<llcare & Me<ltcald SeNioes 

Offic« of the Administrator 

Washington, DC 20201 

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~-t ing 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 OIG’s 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.