TN 50 (09-13)

GN 02602.600 The Medicare Non-utilization Project (MNUP)

Citations:

Social Security Act, Section 202(j), 404.603, 404.610, 404.611, 404.612, 404.613, 404.614, 404.620, 404.621, 404.623, 404.630, 404.631, 404.632, 404.633

A. Introduction for the Medicare Non-Utilization Project

The Medicare Non-Utilization Project (MNUP) is a program integrity initiative using a data exchange between the Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services (CMS). CMS will identify Medicare enrollees who have not used Part A or Part B for three or more years. We will use the data as an indicator to select and prioritize cases for review to determine continued eligibility to title II benefits.

The selection criteria are title II beneficiaries:

  • ages 90 and above,

  • in current pay status, and

  • with a domestic address.

B. Purpose of the Medicare Non-Utilization Project

There are several reasons for interviewing title II beneficiaries who have Medicare, but have not used Part A or Part B in three or more years.

1. Verifying the beneficiary is alive

Studies show that we issue a small percentage of benefits to deceased title II beneficiaries. By interviewing the beneficiary or the representative payee, if applicable, we can verify that he or she is living.

2. Ensuring program integrity

We must verify the identity of the beneficiary who is receiving benefits or payment. We must refer a case to the Office of the Inspector General (OIG) when we suspect fraud.

Immediately refer the case to OIG using form e8551 (Reporting Form for Programmatic Fraud) if you:

  • suspect fraud at any time, or

  • suspend benefits for any reason.

Provide as much information as possible on the e8551.

3. Determining capability

We prefer to pay the beneficiary directly, if possible. If the beneficiary appears capable, we do not require a representative payee. If it becomes apparent during the interview that the beneficiary is not handling his or her affairs or is not capable of continuing to do so, develop for a representative payee. For instructions on Determining Capability for Adult Beneficiaries, see GN 00502.020.

4. Ensuring payment accuracy

Verify that we are paying benefits correctly. Review entitlement factors and adjust payments, if necessary.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0202602600
GN 02602.600 - The Medicare Non-utilization Project (MNUP) - 04/23/2015
Batch run: 04/23/2015
Rev:04/23/2015