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Review of Medicare Payments for Beneficiaries with Institutional Status - Blue Care Network, Southfield, Michigan

Issued on  | Posted on  | Report number: A-05-01-00079

Report Materials

EXECUTIVE SUMMARY:

The objective of this audit was to determine if payments to Blue Care Network (Contract H9009) were appropriate for beneficiaries reported as institutionalized. We determined that Blue Care received Medicare overpayments totaling $100,692 for 54 beneficiaries incorrectly reported as institutionalized during the period January 1, 1998 through December 31, 2000.  The majority of the beneficiaries did not meet the 30-day residency requirement in a qualifying institutional facility.  Blue Care Network should not have received payment at the enhanced institutional rate.

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.