Group Health Cooperative of Puget Sound, Seattle, Washington, Audit Medicare Payments in Behalf of

l 3 Department of Health and Human Services OFFICE OF INSPECTOR GENERAL GROUP HEALTH COOPERATIVE OF PUGET SOUND SEATTLE, WASHINGTON AUDIT OF MEDICARE PAYMENTS MADE ON BEHALF OF BENEFICIARIES CLASSIFIED AS INSTITUTIONALIZED FOR THE PERIOD SEPTEMBER 1994 THROUGH DECEMBER 1995 The designation of financial or management practices as questionable or a recommendation for the disallowance of costs incurred or claimed as well as other conclusions and recommendations in this Final determination on these matters report represent the findings and opinions of the will be made by authorized of the HHS operating divisions. JUNE GIBBS BROWN Inspector Genera NOVEMBER 1997 A-10-97-00002 .f@* of Inspector General DEPARTMENT OF HEALTH Office of Audit Services50 United Nations PlazaRoom 171San Francisco, CA 94102CIN: A- 1 O-97-00002 November Phil Nudelman, President Chief Executive OfficerGroup Health Cooperative of Puget Sound521 Wall StreetSeattle. WA 98121-1536Dear Dr. Nudelman:This report provides you with the results of our audit of enhanced Medicare payments made to Group Health Cooperative of Puget Sound (Group Health) for beneficiaries classified asinstitutionalized. Our audit included Medicare payments made during the period September 1994 through December 1995.Group Health is a managed care organization and has been providing services to Medicare beneficiaries under contract with the Health Care Financing Administration ...