U.S. flag

An official website of the United States government

Dot gov

The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.


The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Department of Health and Human Services

Office of Inspector General -- AUDIT

"Ineligible Medicare Payments To Skilled Nursing Facilities Under The Administrative Responsibility of Anthem Health Plans of New Hampshire, Inc.," (A-05-04-00058)

July 15, 2004

Complete Text of Report is available in PDF format (161 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


The objective of this audit was to determine the extent of ineligible Medicare Skilled Nursing Facility (SNF) payments, attributable to Anthem Health Plans of New Hampshire, Inc. (Anthem), contained in a database of payments made under the administrative responsibility of nine Medicare Fiscal Intermediaries (FI’s).  Our review of the database estimated that $206,495 of ineligible SNF payments were made under the administrative responsibility of Anthem during calendar years 1997 through 2001.  The overpayments occurred due to the absence of an automated cross-check, within the Centers for Medicare and Medicaid Services Common Working File and the Fiscal Intermediary’s (FI) claims processing systems, verifying that a three consecutive day inpatient hospital stay occurred prior to SNF admission.  Anthem will not initiate recovery actions on the ineligible payments within our database due to a CMS memorandum which instructed all FIs not to initiate any recovery actions.