Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Medicare Payments for Beneficiaries with Institutional Status - Kansas City Market-Humana Health Plan, Kansas City, Missouri" (A-05-01-00071)

December 6, 2001

Complete Text of Report is available in PDF format (235kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


This final report provides the results of our audit entitled, "Review of Medicare Payments for Beneficiaries with Institutional Status."  Our objective was to determine if payments to Humana Health Plan (Contract H2649) were appropriate for beneficiaries reported as institutionalized. We determined that Humana received Medicare overpayments totaling $84,808 for 27 beneficiaries incorrectly classified as institutionalized during the period January 1, 1998 through December 31, 2000.  Most of these beneficiaries were residents of domiciliary type facilities that do not qualify a beneficiary for institutional status.  Humana should not have received payment at the enhanced institutional rate.