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

"Audit of Medicare Payments to Pacificare for Beneficiaries Classified as Institutionalized in States Other Than California in January 1998," (A-09-01-00094)

February 8, 2002

Complete Text of Report is available in PDF format (7.01 MB). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


Medicare pays a higher capitation rate for Medicare beneficiaries who are institutionalized.  This final report shows that PacifiCare plans outside California did not implement a policy letter issued by the Centers for Medicare & Medicaid Services in a timely manner.  PacifiCare claimed the higher rate for some beneficiaries who were not institutionalized in December 1997, resulting in overpayments for January 1998. We estimated these overpayments to be in excess of $700,000.