Stay Informed
of New Reports
Twitter
Where To Report Waste
Fraud, Abuse, Or Retaliation
Where To Report Waste Fraud, Abuse, Or Retaliation

Puerto Rico Claimed Over $7 Million in Federal Reimbursement for Medicaid Capitation Payments Made on Behalf of Enrollees Who Were or May Have Been Deceased

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Monday, September 11, 2023
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-02-21-01005
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
External entity, if applicable: 
Puerto Rico Department of Health
Location(s): 
PR,
United States
Type of Report: 
Audit
Questioned Costs: 
$7,864,945
Funds for Better Use: 
$0
Number of Recommendations: 
6
Report updated under NDAA 5274: 
No
View Document: 
AttachmentSize
PDF icon 22101005.pdf2.14 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
23-A-02-112.01 Open No
We recommend that the Puerto Rico Department of Health refund $6,979,822 to the Federal Government.
23-A-02-112.02 Open No
We recommend that the Puerto Rico Department of Health identify capitation payments made on behalf of enrollees with a date of death in the DMF before the month covered by the capitation payments, estimated as $885,123 in Federal Medicaid funds, and refund to the Federal Government the Federal share of any unallowable payment.
23-A-02-112.03 Open No
We recommend that the Puerto Rico Department of Health identify capitation payments made after the audit period on behalf of deceased enrollees and refund to the Federal Government the Federal share of any unallowable payments.
23-A-02-112.04 Open No
We recommend that the Puerto Rico Department of Health develop written policies and procedures to ensure that DOH staff periodically update, at least monthly, DOH's eligibility system with data on deaths recorded in the Puerto Rico Demographic Registry.
23-A-02-112.05 Open No
We recommend that the Puerto Rico Department of Health develop written policies and procedures to use sources other than the Puerto Rico Demographic Registry to identify deceased enrollees.
23-A-02-112.06 Open No
We recommend that the Puerto Rico Department of Health establish a process with ASES to ensure ASES ceases making payments to MCOs on behalf of enrollees after their deaths are recorded in DOH's eligibility system and recoups unallowable payments made on behalf of deceased enrollees.
Displaying 6 of 6 Recommendations