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Medicare Paid Claims for Inmates, Undocumented Residents

Medicare Paid Claims for Inmates, Undocumented Residents, Reports Find

Medicare paid more than $120 million from 2009 to 2011 for claims from  inmates and undocumented residents, violating federal law, according to a pair of reports by HHS' Office of Inspector General, Politico reports.

Details of Reports

According to the reports, nearly 3,000 undocumented residents filed thousands  of claims resulting in $91.6 million in Medicare payments. In addition, 11,600  inmates submitted more than 75,000 claims resulting in $33.6 million in Medicare  payments.

Although CMS already has a system to flag charges for inmates and  undocumented residents, the reports recommended that federal officials establish  a better system. The reports found that the current system does not flag  payments until after they are paid and that CMS does not instruct its  contractors to recoup such payments (Cheney, Politico, 1/24).

CMS' Response

Acting CMS Administrator Marilyn Tavenner in a statement said that some of  the payments could have been legitimate. She said the federal government covers  the medical care of some inmates in states that make prisoners pay for care,  which likely includes some of the inmates who received the Medicare  payments.

Tavenner also said some of the payments to undocumented residents might have  been proper because some individuals had their legal status "retroactively  updated" (Carlson, Modern Healthcare, 1/24).

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