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Review of Medicare Payments for Beneficiaries With Institutional Status

Issued on  | Posted on  | Report number: A-07-03-00151

Report Materials

EXECUTIVE SUMMARY:

The objective of this audit was to determine if capitation payments to IHA (Contract H3362) were appropriate for beneficiaries reported as institutionalized during the audit period.  We determined that IHA received Medicare overpayments totaling approximately $18,400 for 36 beneficiaries incorrectly classified as institutionalized.  The overpayments occurred because of lack of oversight of internal control procedures.  We recommended that IHA refund the overpayments, and ensure policies and procedures regarding the verification of institutionalized beneficiaries are followed correctly.  The IHA concurred with our findings and recommendations.

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.