CMS's Policies and Procedures Were Generally Effective in Ensuring That Capitation Payments Were Not Made After Beneficiaries' Dates of Death
The Centers for Medicare & Medicaid Services (CMS) have policies and procedures in place that are generally effective in ensuring that capitation payments to Medicare Advantage (MA) organizations for Medicare Parts A and B services are not made on behalf of deceased beneficiaries after the individuals' dates of death. During calendar years 2012 through 2015, CMS received updated beneficiary date-of-death information and then made approximately 1.8 million adjustments to capitation payments, thereby recouping $2.96 billion from MA organizations for Parts A and B capitation payments that have been made on behalf of beneficiaries who died.
CMS does not, however, identify and recoup all improper capitation payments. As of March 7, 2017, CMS has not recouped $2.4 million associated with 1.817 capitation payments that made on behalf of 978 beneficiaries. 
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Translation
For our audit period, these improper payments represented .0004 percent of the total capitation payments made to MA organizations and .08 percent of the total adjustments that CMS made after receiving information on beneficiaries' dates of death.
We recommended that CMS recoup the $2.4 million in capitation payments made to MA organizations for Medicare Parts A and B services on behalf of deceased beneficiaries, and that CMS implement system enhancements to identify, adjust, and recoup improper capitation payments in the future. CMS concurred with both of our recommendations and described corrective actions that it had implemented.
Filed under: Center for Medicare and Medicaid Services