Audit of Medicare Payments to PacifiCare of California for Beneficiaries Classified as Institutionalized During the Period October 1, 1996 through December 31, 1999

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.