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Audit of Medicare Payments to PacifiCare of California for Beneficiaries Classified as Institutionalized in January 1998

Issued on  | Posted on  | Report number: A-09-01-00056

Report Materials

EXECUTIVE SUMMARY:

The objective of this review was to determine if enhanced Medicare payments made to PacifiCare of California (PacifiCare) were appropriate for beneficiaries classified as institutionalized in January 1998.  We estimate that PacifiCare received Medicare overpayments of at least $2,083,163 for beneficiaries incorrectly classified as institutionalized in January 1998.  We recommended that PacifiCare: (1) refund the specific overpayments of $66,658 identified in the sample; (2) coordinate with CMS to ensure that adjustments already submitted, totaling $8,756, are processed; and (3) review the balance of the institutionalized beneficiary universe to identify and refund additional overpayments (total overpayments are estimated to be $2,083,163).

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

Notice

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