Review of Institutional Medicare Beneficiaries' Minimum Data Set Classification for Harmony Health Plan of Illinois, Inc. (Contract Number H1416) for Calendar Year 2008

摘要

Harmony Health Plan of Illinois, Inc. (Harmony), a wholly-owned indirect subsidiary of WellCare Health Plans, Inc., an organization headquartered in Tampa, Florida, entered into contract number H1416 with CMS as a point-of-service health maintenance organization. Our audit covered all plans under the contract that identified 62 unique Medicare beneficiaries as having institutional status during the period January 1, 2008, through December 31, 2008. During this period, CMS paid Harmony $873,329 for these 62 unique Medicare beneficiaries. Our objective was to determine whether all 62 beneficiaries, for which Harmony received Medicare capitated payments using the long-term institutional residents model, were correctly classified as institutional.