“Medicare generally does not pay for services rendered to incarcerated beneficiaries,” the audit states. These include individuals who are “under arrest, incarcerated, imprisoned, escaped from confinement, under supervised release, on medical furlough, required to reside in mental health facilities, required to reside in halfway houses, or required to live under home detention, or confined completely or partially in any way under a penal statute or rule.”
Laws governing the agency require it to ensure that payments for Medicare services are not made to incarcerated beneficiaries. The agency is required to take steps to prevent improper payments from occurring and recoup improper payments if they are made.
“Both [Centers for Medicare and Medicaid Services] policies and procedures to ensure that payments are not made for Medicare services rendered to incarcerated beneficiaries and its planned revisions to those policies and procedures, did not comply with Medicare requirements,” the audit said.