Tennessee Managed Care Organizations Received Medicaid Capitation Payments After Beneficiary's Death

Tennessee did not always stop making capitation payments after a beneficiary's death, despite its efforts to identify and recover any unallowable payments. Of the 120 capitation payments in our random sample selected from payments for beneficiaries whose dates of death (DODs) preceded the payment dates, Tennessee recovered 43 prior to the start of our audit, and 13 were not recoverable. For the remaining 64 payments, Tennessee made unallowable payments totaling $39,909 ($27,357 Federal share). During our audit, Tennessee adjusted 35 of the 64 payments totaling $23,614. On the basis of our sample results, we estimated that Tennessee made overpayments to managed care organizations (MCOs) totaling $2.7 million ($1.8 million Federal share) during our audit period. These unallowable payments amount to less than 1 percent of the $3.8 billion that the Tennessee paid to MCOs from July 1, 2009, through March 4, 2016.