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EXECUTIVE SUMMARY:
The objective of this audit was to determine if Medicare payments to HealthCarePlan (HCP) were appropriate for beneficiaries reported as institutionalized. We determined HCP received Medicare overpayments totaling $27,201 for 31 beneficiaries incorrectly classified as institutionalized. The 31 beneficiaries were part of a statistical sample of 100 Medicare beneficiaries reported as institutionalized during the period October 1, 1994 through September 30, 1996. Based on our sample results, we estimate that HCP received Medicare overpayments of at least $36,020 for beneficiaries incorrectly classified as institutionalized during the audit period.