EXECUTIVE SUMMARY:
Medicare pays a higher capitation rate for Medicare beneficiaries who are institutionalized. This final report points out that PacifiCare of California claimed the higher rate for some beneficiaries who were not institutionalized for the period claimed resulting in overpayments totaling $14,278. PacifiCare had already submitted adjustments for $7,719 and, as a result of our audit, submitted additional adjustments for the remaining $6,559.