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Review of Medicare Payments for Beneficiaries with Institutionalized Status at Health Net of California

Issued on  | Posted on  | Report number: A-07-05-01013

Report Materials

EXECUTIVE SUMMARY:

The objective of our review was to determine if Health Net reported beneficiaries as institutionalized for enhanced Medicare reimbursement pursuant to Federal laws and regulations.   Health Net incorrectly reported 82 beneficiaries as institutionalized for enhanced Medicare reimbursement.  As a result, Health Net received Medicare overpayments of $293,885.  The errors occurred because Health Net did not have adequate internal controls to ensure that it correctly classified beneficiaries as institutionalized.

We recommended Health Net refund $293,885 to the Federal Government and ensure that its controls are adequate to correctly classify beneficiaries as institutionalized pursuant to Federal laws and regulations.  Health Net concurred with our findings and recommendations.

Report Type
Audit
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
-
Target Groups
-
Financial Groups
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Notice

This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.