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Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Medicare Payments for Beneficiaries with Institutional Status," (A-07-03-00151)

June 26, 2003

Complete Text of Report is available in PDF format (1.15 mb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


The objective of this audit was to determine if capitation payments to IHA (Contract H3362) were appropriate for beneficiaries reported as institutionalized during the audit period.  We determined that IHA received Medicare overpayments totaling approximately $18,400 for 36 beneficiaries incorrectly classified as institutionalized.  The overpayments occurred because of lack of oversight of internal control procedures.  We recommended that IHA refund the overpayments, and ensure policies and procedures regarding the verification of institutionalized beneficiaries are followed correctly.  The IHA concurred with our findings and recommendations.