Review of Medicare Payments for Beneficiaries with Institutional Status - Kansas City Market-Humana Health Plan, Kansas City, Missouri

This final report provides the results of our audit entitled, "Review of Medicare Payments for Beneficiaries with Institutional Status."  Our objective was to determine if payments to Humana Health Plan (Contract H2649) were appropriate for beneficiaries reported as institutionalized. We determined that Humana received Medicare overpayments totaling $84,808 for 27 beneficiaries incorrectly classified as institutionalized during the period January 1, 1998 through December 31, 2000.  Most of these beneficiaries were residents of domiciliary type facilities that do not qualify a beneficiary for institutional status.  Humana should not have received payment at the enhanced institutional rate.