Review of Medicare Payments for Beneficiaries With Institutional Status at United Healthcare of Ohio

EXECUTIVE SUMMARY:

The objective of our review was to determine if capitation payments to United were appropriate for beneficiaries reported as institutionalized for the audit period.  We found that United received Medicare overpayments of $13,128 for 20 beneficiaries incorrectly reported as institutionalized.  United officials stated the errors occurred because United made administrative and clerical errors and because the institutions did not always provide correct information to verify the institutionalized status of the beneficiaries. We recommended that United refund $13,128 to the Federal Government and ensure capitation payments for beneficiaries reported as institutionalized are claimed in accordance with Federal laws and regulations.  United agreed with our findings and recommendations.