Medicare Paying for Surgeries on Dead Patients?
Sep 06, 2011, 04:33 ET
WAYNE, Pa., Sept. 6, 2011 /PRNewswire/ -- The Centers for Medicare and Medicaid Services (CMS) paid millions of dollars in benefits for dead Americans between 2004 and 2008 according to a new study by PearlDiver Technologies.
PearlDiver's analysts found that between 2004 and 2008, CMS paid for 142,000 procedures by 2,119 hospitals or clinics on approximately 4,980 dead patients. Eventually, CMS paid $33 million for those claims.
The type of procedures performed on patients coded as "dead" included arthrocentesis aspiration of a major joint, total knee replacements, total hip replacements, stent implants, hemodialysis and fracture repair.
This isn't the first time that the Centers for Medicare and Medicaid Services have been found to pay for the dead.
Paying Dead Doctors
In July, 2008 the Senate Permanent Subcommittee on Investigations reported that Medicare paid tens of millions of dollars to suppliers improperly using identification numbers of doctors who died years earlier.
According to the subcommittee's 2008 report; "From 2000 to 2007, Medicare paid 478,500 claims containing identification numbers that were assigned to deceased physicians. The total amount paid for these claims is estimated to be between $60 million and $92 million. These claims contained identification numbers for an estimated 16,548 to 18,240 deceased physicians."
Fixing the Dead Doctor Dilemma
As a result of the OIG audit, CMS updated, corrected and, where necessary, deactivated invalid doctor ID numbers. Additionally, CMS began to rely on the Social Security Administration's (SSA) Death Master File to double check its data records for dead doctors.
But Wait, Even Social Security is Paying Dead People
Earlier this summer the Office of Inspector General reported that the Social Security Administration erroneously coded approximately 14,000 Americans as dead in its Death Master File.
In its report, the OIG said that such "erroneous death entries can lead to benefit termination, cause severe financial hardship and distress to affected individuals." In Southern California and elsewhere last year, OIG investigators reviewed 305 Social Security beneficiaries who were recorded as deceased in their Social Security Administration files. At least 140 of them were still alive.
All told, investigators say, more than 6,000 current Social Security beneficiaries are recorded as being deceased. An untold number of them are still, in fact, alive.
Social Security officials have agreed to investigate the correct status of 6,733 potentially deceased individuals identified in the OIG investigation's audit.
The OIG found that $2 million in improper payments were made to the 88 deceased Social Security beneficiaries. The investigators further identified 6,733 Social Security benefit recipients whose master files "contained a date of death." Extrapolating from their smaller sample, investigators estimated that more than $40 million may have been paid out improperly to deceased beneficiaries.
As a result of the new study, at least three dozen potential criminal cases have been forwarded to the agency's Office of Investigations for further inquiry and possible prosecution.
Paying for Surgeries on Dead Patients
There are 1,908,435 patients coded as "dead" by healthcare providers and are included in PearlDiver's CMS database from 2004 to 2008. Of those patients, according to the PearlDiver analysis, approximately 1 out of every 400 deceased Medicare patients had one or more further medical procedures. Every single patient included in this PearlDiver study received their follow-on surgeries three months or longer after their demise. So, for example, if a patient died in March, 2006 but then had a hip replacement 90 days or longer after death (say, in July, 2006), they were included in the PearlDiver study.
How did PearlDiver discover these needles in the CMS data haystack?
In the words of its President, Benjamin Young; "PearlDiver employs Big Data third generation longitudinal tracking algorithms which allow it to mine the entire 2 billion record data base rapidly and efficiently. As a result, in a matter of minutes PearlDiver was able to mine the entire Medicare database and thereby discover payments to patients who had "died." More typical methods of data mining which employ sampling techniques would not have found these anomalies. "
PearlDiver is a four year old medical data aggregator which started with about 20 million private payer records and is today one of the largest medical data sources in the world with more than 2 billion U.S. patient records.
All records in the PearlDiver data base are HIPAA compliant and no individual patient identities are known or available to PearlDiver analysts.
Underlying PearlDiver's data is a search and organization engine that allows researchers to mine entire databases. The ability to mine an entire database is also known as Big Data capability and it is extremely unusual. More typically, data mining companies employ sampling techniques to handle extremely large databases.
Because of PearlDiver's Big Data ability, it can uncover such anomalies as, for example, payments for dead Medicare patients. A sampling approach, on the other hand, which examines perhaps 1 in 100 records, would miss an event that occurs in 1 in 400 records – which these payments did.
In many ways, the future of healthcare is about improving ways that data is mined, interpreted and used to guide clinical and resource decisions. The curious fact that Medicare is paying for surgeries on dead people (or patients who'd been coded as "dead") is a stark illustration that the current data mining infrastructure for medicine is not yet prepared for the complexities of a changing and increasingly constrained healthcare system.
For more information about PearlDiver's software and data mining capabilities contact Benjamin Young, President at 719-238-8763 or email him at [email protected].
Contact: Robin Young, CEO PearlDiver, Inc.
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