Review of Medicare Payments for Beneficiaries with Institutional Status - Humana Health Plan

This report provides the results of our audit entitled, "Review of Medicare Payments for Beneficiaries with Institutional Status." Our objective was to determine if capitation payments to Humana Health Plan (H1406) were appropriate for beneficiaries reported as institutionalized.

We found that Medicare payments to Humana for beneficiaries reported as institutionalized were generally correct. Our results are based on a statistical sample of 100 Medicare beneficiaries reported as institutionalized during the period October 1, 1994 through September 30, 1996. We determined the beneficiaries in our sample were correctly reported as institutionalized, with the exception of minor errors. The positive results are attributed to Humana's procedures for verifying the institutional status of its beneficiaries.