Department of Health and Human Services

"Review of Medicare Payments for Beneficiaries with Institutional Status - Blue Care Network, Southfield, Michigan," (A-05-01-00079)

June 10, 2002


Complete Text of Report is available in PDF format (134kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

The objective of this audit was to determine if payments to Blue Care Network (Contract H9009) were appropriate for beneficiaries reported as institutionalized. We determined that Blue Care received Medicare overpayments totaling $100,692 for 54 beneficiaries incorrectly reported as institutionalized during the period January 1, 1998 through December 31, 2000.  The majority of the beneficiaries did not meet the 30-day residency requirement in a qualifying institutional facility.  Blue Care Network should not have received payment at the enhanced institutional rate.