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Review of Medicare Payments for Beneficiaries Reported as Institutionalized by Penn State Geisinger Health Plan

Issued on  | Posted on  | Report number: A-03-00-00010

Report Materials

EXECUTIVE SUMMARY:

Medicare pays a higher capitation rate for Medicare beneficiaries who are institutionalized. This final report points out that the Penn State Geisinger Health Plan (PSGHP) claimed the higher rate for beneficiaries that were not institutionalized for the period(s) claimed. Based on a statistical sample, we estimate that overpayments totaled $306,269 over the 3-year period ending December 31, 1999. In addition to financial adjustments, we recommended that PSGHP strengthen the internal controls for identifying, monitoring, and billing the Medicare program for institutional status beneficiaries.

Report Type
Audit
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
-
Target Groups
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Financial Groups
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Notice

This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.