Medicare Advantage Organizations Were Improperly Paid Millions of Dollars for Unlawfully Present Aliens

Cornelia Dorfschmid | September 2014

The Office of Inspector General (OIG) is conducting a series of reviews examining Medicare payments made on behalf of individuals who are unlawfully in the United States. It recently reported that Medicare made payments to health care providers for services to such individuals under Parts A and B fee-for services (FFS) program.1 It has now released another report that found $26.2 million in improper payments were made by the Centers for Medicare & Medicaid Services (CMS), under Part C, to Medicare Advantage (MA) organizations for approximately 1,600 unlawfully present beneficiaries.2


1. Medicare Improperly Paid Providers Millions of Dollars for Unlawfully Present Beneficiaries Who Received Services During 2009 Through 2011. A-07- 12-01116. Medicare made improper Part A and B payments of $91.6 million, region7/71301125.pdf.

2. Medicare Improperly Paid Medicare Advantage Organizations Millions of Dollars for Unlawfully Present Beneficiaries for 2010 through 2012. A-07- 01125.

About the Author

Dr. Cornelia M. Dorfschmid has over 30 years of private and government sector experience in health care compliance consulting, the majority of which was in management and executive capacities. She is a recognized expert in the areas of claims auditing, overpayment analysis and risk management and corporate health care compliance.