Department of Health and Human Services

"Review of Medicare Payments for Beneficiaries with Institutional Status - Kaiser Foundation Health Plan, Inc., Oakland, California," (A-05-01-00094)

October 17, 2002

Complete Text of Report is available in PDF format (312 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


This final report points out that the Kaiser Foundation Health Plan, Inc., received Medicare overpayments totaling $229,656 for 315 beneficiaries incorrectly reported as institutionalized during the period January 1, 1998 through December 31, 2000.  Institutional status requirements specify that a beneficiary must be a resident of a qualifying facility for a minimum of 30 consecutive days immediately prior to the first day of the current reporting month.  The 315 beneficiaries included 266 that had admittance or discharge dates during the 30-day residency period.  The remainder consisted of: 16 beneficiaries residing in facilities not certified for Medicare or Medicaid; 28 beneficiaries for whom institutional residency could not be documented; and 5 beneficiaries with hospitals stays greater than 15 days.