States Paid Millions to Medicaid Plans for Dead Beneficiaries, Watchdog Says

December 8

State Medicaid programs have sent substantial amounts of capitation payments to managed care organizations for covering members who have died, a new report from the HHS Office of Inspector General (OIG) found. The problem has bedeviled Medicaid agencies and plans for a long time, Medicaid insiders say, and is indicative of outdated and underfunded data systems.

States paid $249 million in improper capitation payments for deceased Medicaid enrollees between 2009 and 2019, OIG found. In addition, the report said, three states have not recouped a combined outstanding balance of $41 million in such payments: Health plans owe the states of Michigan $27.5 million, New York $3.6 million and Kansas $9.7 million.

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Health Plan Weekly

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.