U.S. flag

An official website of the United States government

Dot gov

The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Medicare Payments Made to Pacificare of California for Medicaid Special Status Beneficiaries for the Period January 1, 1995 through December 31, 1998," (A-09-00-00103)

May 23, 2001


Complete Text of Report is available in PDF format (3.95 MB). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

Medicare pays an enhanced rate to health maintenance organizations for beneficiaries who are enrolled in both Medicare and Medicaid.  The beneficiaries for whom the enhanced rate is paid are referred to as Medicaid special status beneficiaries.  This final report points out that Medicare overpaid PacifiCare of California $1,438,782 during the period January 1, 1995 through December 31, 1998 for Medicare special status beneficiaries who were not actually eligible for Medicaid during the months for which the overpayments were made.