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Review of Medicare Payments for Beneficiaries with Institutional Status - Fallon Community Health Plan, Worcester, Massachusetts

Issued on  | Posted on  | Report number: A-05-01-00100

Report Materials

EXECUTIVE SUMMARY:

The objective of this review was to determine if payments to Fallon Community Health Plan (Contract H9001) were appropriate for beneficiaries reported as institutionalized.  The final report points out that Fallon received Medicare overpayments totaling $18,842 for 44 beneficiaries incorrectly classified as institutionalized during the period January 1, 1998 through December 31, 2000.  All of the beneficiaries were residents of domiciliary type facilities that did not qualify a beneficiary for institutional status.  Fallon 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.