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Department of Health and Human Services

"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.