Review of Mutual of Omaha Medicare Payments to Long-Term Care Hospitals From January Through May 2003

EXECUTIVE SUMMARY :

The objective of our review was to determine whether Mutual of Omaha (the Intermediary) paid long-term care hospitals' (LTCH) claims in accordance with Medicare requirements when beneficiaries had used all of their regular covered benefit days. The Intermediary did not always pay LTCH claims in accordance with Medicare requirements when the beneficiaries had used all of their regular covered benefit days. As a result, the Intermediary made overpayments totaling $374,945 for 33 claims to 21 LTCHs for services provided from January 1 through May 31, 2003. We recommended that the Intermediary recover the $374,945 in overpayments and work with CMS to determine the appropriate actions for recovering the portion of the overpayments related to the beneficiaries' coinsurance payments. The Intermediary generally agreed to implement our recommendations.