Follow-Up Review of Medicare Payments For Institutionalized Beneficiaries - Medica Health Maintenance Organization

EXECUTIVE SUMMARY:

The objective of this audit was to determine if Medica corrected the problem of improper institutional classifications that resulted in Medicare overpayments, as presented in our previous audit report, issued in May 1995.  Although Medica attempted corrective actions to address the problem, Medicare overpayments have continued.  Based on the projection of the results of a sample of 100 beneficiaries receiving institutional payments during the period of June 1, 1998 through May 31, 2000, we are recommending that Medica refund an additional $133,795 in estimated Medicare overpayments.