Department of Health and Human Services

Review of Medicare Payments for Beneficiaries with Institutional Status - Inter Valley Health Plan, Pomona, California
(A-05-01-00096)

May 23, 2002


Complete Text of Report is available in PDF format (207kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

The objective of this review was to determine if payments to Inter Valley Health Plan (Contract H0545) were appropriate for beneficiaries reported as institutionalized.  The final report points out that Inter Valley received Medicare overpayments totaling $319,355 for 27 beneficiaries incorrectly reported as institutionalized during the period January 1, 1998 through December 31, 2000.  Twenty-six of the identified beneficiaries were residents of domiciliary facilities that did not qualify a beneficiary for institutional status.  Inter Valley should not have received payment at the enhanced institutional rate.