Department of Health and Human Services

Review of Medicare Payments for Beneficiaries with Institutional Status - Fallon Community Health Plan, Worcester, Massachusetts

May 14, 2002

Complete Text of Report is available in PDF format (196kb). 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 Fallon Community Health Plan (Contract H9001) were appropriate for beneficiaries reported as institutionalized.  The final report points out that Fallon received Medicare overpayments totaling $18,842 for 44 beneficiaries incorrectly classified as institutionalized during the period January 1, 1998 through December 31, 2000.  All of the beneficiaries were residents of domiciliary type facilities that did not qualify a beneficiary for institutional status.  Fallon should not have received payment at the enhanced institutional rate.