Review of Medicare Payments for Beneficiaries with Institutional Status - Providence Good Health Plan, Portland, Oregon

This report provides the results of our audit entitled, "Review of Medicare Payments for Beneficiaries with Institutional Status." Our objective was to determine if payments to Providence Good Health Plan under Medicare risk contract H9047 were appropriate for beneficiaries reported as institutionalized.

We found that Medicare payments to Providence for beneficiaries reported as institutionalized were generally correct. Our results are based on a statistical sample of 100 Medicare beneficiaries reported as institutionalized, with the exception of minor errors. The positive results are attributed to Providence's procedures for verifying the institutional status of its beneficiaries.