"Review of Medicare Payments for Beneficiaries with Institutional Status, Humana Health Plans, Phoenix, Arizona," (A-05-01-00095)
June 25, 2002
Complete Text of Report is available in PDF format (353kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.
The objective of this review was to determine if payments to Humana (Contract H0307) were appropriate for beneficiaries reported as institutionalized. We determined that Humana received Medicare overpayments totaling $18,645 for 37 beneficiaries incorrectly reported as institutionalized during the period January 1, 1998 through December 31, 2000. The 37 beneficiaries include 23 that did not meet the 30-day residency requirement in an institutional facility, five beneficiaries for whom Humana staff could provide no institutional residency information and 9 beneficiaries residing in non-certified facilities.