CMS Paid Medicare Advantage Organizations for Services Provided to Beneficiaries Confined in Mental Health Facilities for Court-Ordered Purposes

In this report released on June 11, 2014, the Office of the Inspector General (OIG) for the federal Department of Health and Human Services (HHS) analyzed an inconsistency in Medicare policy that allowed Medicare Advantage plans to receive capitated payments for enrolled members who were incarcerated in mental institutions under a forensic committment. The OIG found that from January 1, 2011 through December 31, 2012, Medicare made 1,018 payments on behalf of 207 Medicare Advantage beneficiaries in mental institutions due to criminal offenses. Generally, under traditional Medicare Parts A and B, payment for such beneficiaries would not have been . . .