Review of Medicare Payments Made to Pacificare of California for Medicaid Special Status Beneficiaries for the period January 1, 1995 through December 31, 1998

EXECUTIVE SUMMARY:

Medicare pays an enhanced rate to health maintenance organizations for beneficiaries who are enrolled in both Medicare and Medicaid.  The beneficiaries for whom the enhanced rate is paid are referred to as Medicaid special status beneficiaries.  This final report points out that Medicare overpaid PacifiCare of California $1,438,782 during the period January 1, 1995 through December 31, 1998 for Medicare special status beneficiaries who were not actually eligible for Medicaid during the months for which the overpayments were made.