Review of Medicare Payments For Beneficiaries With Institutional Status - Maricopa Count Health Plan

EXECUTIVE SUMMARY:

The objective of this audit was to determine if Medicare payments to Maricopa Health Plan were appropriate for beneficiaries reported as institutionalized.  We found that Medicare payments to Maricopa 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 Maricopa's procedures for verifying the institutional status of its beneficiaries.