Performance Improvement 2009. Do Medicare and Medicaid Duplicate Each Others' Payments for Supplies or Services?


This study examined whether duplicate payments were being made by Medicare and Medicaid. Medicare and Medicaid pay home health providers for services but should not pay for the same medical supplies or services for the same beneficiary. Home health services seek to restore health and minimize the effects of illness and disability, thereby enabling beneficiaries to reside in community settings and avoid institutionalization.

In four of the five States reviewed, Medicaid inappropriately paid $1 million in 2005 for nonroutine medical supplies and therapeutic services that were paid by Medicare; Medicaid paid $6.6 million for routine medical supplies on the same dates as home health services; and States controls to prevent duplicate payments did not eliminate all inappropriate payments. State officials reported that they lacked direct access to Medicare claims data to determine whether Medicare had already paid. The Centers for Medicare & Medicaid Services offered a simplification which involves Medicare sending a copy of the denial of payment notice to the State Medicaid program and to clarify policy on coverage of routing medical supplies under Medicare’s home health prospective payment system.

Report Title: Duplicate Medicaid and Medicare Home Health Payments: Medical Supplies and Therapeutic Services
Agency Sponsor: OS-OIG, Office of Inspector General
Federal Contact: Erin Lemire, 202-205-9523
Performer: Staff; Office of Inspector General
PIC ID: 9004

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