The Office of the Inspector General recommended that the Puerto Rico Department of Health (DOH) reimburse $6,979,822 to the federal government for Medicaid funds that were paid out to patients who had died or are believed to have died. In addition, the office asked that another $885,123 in potentially irregular payments be reviewed, with any excess money being reimbursed to the federal government.
The OIG randomly examined 105 cases, all within the period from April 1, 2018 to Sept. 30, 2020, and could only confirm that three of those patients were still alive.
"These unallowable and potentially unallowable payments occurred because DOH's controls were not sufficient to identify deceased enrollees," the Office of Inspector General's report detailed.
The OIG detailed in the report that the DOH generally agreed with the recommendations. “DOH generally concurred with our recommendations. DOH partially concurred with our recommended refund because, according to DOH, ASES has recovered capitation payments related to our sample,” the office explained.
Finally, the report noted that previous OIG audits identified inadmissible federal Medicaid reimbursements for managed care payments made on behalf of deceased enrollees. "We audited the Puerto Rico Department of Health (DOH) because we previously identified factors that may increase the risk of similar overpayments," it said.
