Medicare Advantage: Required Audits of Limited ValueDIANE Publishing, 2007 |
Other editions - View all
Medicare Advantage: Required Audits of Limited Value United States Government Accountability Office No preview available - 2018 |
Medicare Advantage: Required Audits of Limited Value United States Government Accountability Office No preview available - 2017 |
Common terms and phrases
2006 bid audits 2006 bid submissions ACRP actuarial firms Actuarial Standards address identified deficiencies Appendix ASOP audit bids audit findings audited organizations audits for contract benchmark bid audit process bid audit reports bid forms bid preparation bid process CMS contracted conflicts of interest contract year 2006 contractor copayments cost sharing coverage determine enrollees estimated financial audit financial records financial recoveries based financial reviews findings and observations firms to audit Government Accountability Office health maintenance organizations HPMS impact on beneficiaries implementing regulations intermediate sanctions Medicare Advantage program Medicare beneficiaries Medicare Part D Medicare Prescription Drug meet the one-third Number of organizations OACT officials OFM staff one-third audit requirement one-third requirement organizations and prescription organizations audited organizations based participating organizations percent plan benefit package plans audited plans offered preferred provider organization premiums prescription drug plans procedures provider-sponsored organization pursue financial recoveries recommendations requirement for contract submit worksheet
Popular passages
Page 31 - Labor and other interested parties. We will also make copies available to others upon request. In addition, the report will be available at no charge on GAO's Web site at http://www.gao.gov. If you or your staff have any questions about this report, please contact me at (202) 512-7215 or robertsonr@gao.gov.
Page 43 - Comments from the Department of Health and Human Services Centers for Medicare & Medicaid Services' (CMS) Comments to the Government Accountability Office's (GAO) Draft Report...
Page 8 - Act of 1997,14 which replaced an existing managed care program with the Medicare+Choice program in an effort to expand beneficiaries' managed care options. For oversight of the program, the act also required that CMS annually audit the financial records of at least onethird of the organizations participating in the Medicare+Choice program, including the organizations...
Page 7 - CMS contracted with six firms to audit a selected number of contract year 2006 bids and plans to do so for subsequent years. In reviewing the 2006 bid audit reports, we determined that 18 (about 23 percent) of the 80 organizations audited had material findings that have an impact on beneficiaries or plan payments approved in bids. CMS defined material findings as those that would result in changes in the total bid amount of 1 percent or more or in the estimate for the costs per member per month of...
Page 1 - Did This Study In fiscal year 2006, the Centers for Medicare & Medicaid Services (CMS) estimated it spent over $51 billion on the Medicare Advantage program, which serves as an alternative to the traditional feefor-service program. Under the Medicare Advantage program, CMS approves private companies to offer health plan options to Medicare enrollees that include all Medicare-covered services.
Page 8 - Definition of preferred provider organization plan In this paragraph, the term "preferred provider organization plan" means a Medicare+Choice plan that — (i) has a network of providers that have agreed to a contractually specified reimbursement for covered benefits with the organization offering the plan; (ii) provides for reimbursement for all covered benefits regardless of whether such benefits are provided within such network of providers; and (iii) is offered by an organization that is not...
Page 29 - Amend the implementing regulations for the Medicare Advantage Program and Prescription Drug Program to provide that all contracts CMS enters into with Medicare Advantage organizations and prescription drug plan sponsors include terms that inform these organizations of the audits and give CMS authority to address identified deficiencies, including pursuit of financial recoveries. If CMS does not believe it has the authority to amend its implementing regulations for these purposes, it should ask Congress...
Page 17 - Figure 1: Time Elapsed from Contract Year 2006 Bid Submissions to Reviews to Meet Audit Requirement Early June 2005 (first Monday) Organizations submit bids to CMS Early June...
Page 17 - MA organizations. The auditors reported findings ranging from lack of supporting documentation to overstating or understating certain costs, but did not identify how the errors affected beneficiary benefits, copayments, or premiums. In...
Page 12 - CMS has not met the statutory requirement to audit the financial records of at least one-third of the participating MA organizations for contract years 2001-2005, nor has it done so yet for the contract year 2006 bid submissions.