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Review of Medicare Payments for Beneficiaries with Institutional Status, Humana Health Plans, Phoenix, Arizona

Issued on  | Posted on  | Report number: A-05-01-00095

Report Materials

EXECUTIVE SUMMARY:

The objective of this review was to determine if payments to Humana (Contract H0307) were appropriate for beneficiaries reported as institutionalized.  We determined that Humana received Medicare overpayments totaling $18,645 for 37 beneficiaries incorrectly reported as institutionalized during the period January 1, 1998 through December 31, 2000.  The 37 beneficiaries include 23 that did not meet the 30-day residency requirement in an institutional facility, five beneficiaries for whom Humana staff could provide no institutional residency information and 9 beneficiaries residing in non-certified facilities.

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.