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Mr. SIMMONS. Excuse me. In this particular plan, two automobiles were owned.

The 21 executive vehicles referred to, which include the 13 that we contracted for on the line, they were leased.

Mr. DUNCAN. By whom?
Mr. SIMMONS. By the contractor.
Mr. DUNCAN. And charged to the medicare plan?

Mr. SIMMONS. A portion of the costs were charged to medicare, yes, sir.

Mr. DUNCAN. Wouldn't it be better just to require certain mileage allowance instead of owning the vehicles?

It looks to me like a pretty sloppy operation.
Mr. Simms. We are coming to that, Congressman.
Mr. DUNCAN. You mean in your statement?
Mr. Simms. Yes, sir.
Mr. Duncan. Thank you.
Mr. STARK. Proceed.

Mr. STEPNICK. At another contractor, we found that an incorrect allocation formula resulted in charges to medicare of $11,466 during 1973-75 for costs of using automobiles for nonbusiness purposes.

Mr. STARK. And that was where, if I may ask?
Mr. STEPNICK. This was at Blue Cross, Maine.
Mr. STARK. Thank you.

Mr. STEPNICK. At four other contractors tests of reported vehicle usage did not indicate that the number of vehicles was excessive.

We checked into use of contractor-owned aircraft at five contractors. In one case, none of the aircraft costs was charged to medicare, and in another case the flight costs charged to medicare were reasonable based on comparisons with the costs of similar trips by commercial airlines and privately owned automobiles.

Limited tests at the other three contractors, however, showed that alternative modes of transportation were from 40 to 57 percent less costly than the contractors' aircraft.

Further analysis is required to develop the total dollar impact on medicare.

Mr. STARK. Could I interrupt there?

If you are looking at that chart, as I do while we are talking, if we could take Blue Cross Maryland with about 1.5 million membership and travel expenses of $135,000 in round figures, and then take Blue Cross of Milwaukee, Wis., which is one that has come up in the question of owning the plane and so forth, with a few more members, 1.7 million roughly, though it has the same membership, it has $815,000, about five or six times the travel expense.

I don't know whether Maryland's name has come up as a luxury auto State and aircraft State, but I know the Milwaukee plan has.

I know from driving across and throughout and travelling and living in both of those States that there isn't a whole lot of difference to cover Maryland as there is in Wisconsin.

There would be a little more snow in Wisconsin. I wonder again in your opinion, unless you would also say that Maryland is a State where you discovered a lot of loose travel, that there is an indication that maybe these people just run around a wholo heck of a lot more.

Maybe they have a third as many executives and they move faster so the travel costs are higher and their salaries are a lot lower.


Is that maybe an indication that they are just used to being comfortably transported because the numbers just seem so glaringly out of kilter?

Can you comment on that, Mr. Stepnick?

Mr. ŠTEPNICK. Wisconsin was one of the places that had contractorowned aircraft.

In that case we thought that the costs charged to medicare were in line with the costs of alternative modes of the transportation.

I am unable to explain the variation between Maryland and Wisconsin.

Mr. STARK. There was the plane in Wisconsin that was used for personal travel, I understand, by the executives. I don't know whether that was brought up in your study or by the press.

I don't know whether your audit found it, because they may not have been charged to the Federal Government.

Mr. STEPNICK. I think that this was the conclusion that we reached, that it wasn't being charged to the Federal Government.

Mr. STARK. But you had no cases, just parenthetically, of the plane being used for personal travel by the executives and then you went on to examine further and found that it was not billed to the Government?

Mr. SIMMONS. Sir, I don't have information to indicate that that would be true.

Our specific tests were as to medicare usage and I don't have information to indicate that we found it to be used for personal

Mr. STARK. All right. Thank you.

If you dwell on that at a later date and would care to submit for the record, as I say, it appears when you have five or six times as much travel costs for one Blue Cross plan, which seems approximately the same geographic and membership distribution, roughly the same asset sort of structure, there might be an explanation for that, other than just inefficient administration.

I would be interested, if you would ponder that a little later, if you would care to submit


have on that. Mr. STEPNICK. All right, we will, sir. Mr. STARK. Thank you.

Mr. STEPNICK. At one contractor—this is the concluding portion of our special audit on transportation, we noted two other types of questionable charges to medicare:

1. Unjustified first-class airfares rather than the lower tourist rate.

2. Costs of meetings at locations which required extensive travel and at expensive lodging rates. Additional audit work will be done on these points.

Mr. STARK. One last interjection here. Is this the reference to the Des Moines, Iowa plan?

Mr. STEPNICK. This is the situation that you talked about in connection with the last witness, yes, sir.

Mr. STARK. I would like to quote from your May 13 audit report on this plan and see if you could correct me if there have been any changes since the transmittal of that report.

You cite an example of extensive travel with family members to expensive places.

any ideas

An example of this was a 4-day meeting, June 29 to July 2, 1975, at the Four Seasons Lodge in the Lake of the Ozarks, Mo. The total cost incurred for the 4 days was $24,000, of which $3,800 was charged to Federal programs.

This meeting was attended by 40 plan employees and board members. Included in the total of incurred costs and the amount charged to the Federal program was the lodging and meal costs of family attendance of the attendees.

My question is whether that is still accurate. Is that the case?

Mr. STEPNICK. We received the response from the plan. As you know, this information was included in the draft report. The response did not dispute the facts in the situation at all.

They indicated that it was considered necessary for part of an educational program and they felt the costs were reasonable.

Mr. STARK. Is this the same plan which replied to your comment on their luxury automobiles?

Our policy is based on the fact that it reflects success, inspires other employees, and presents an image commensurate with the position?

Mr. Simms. It is the same plan.
Mr. STARK. Thank you.
Mr. DUNCAN. Why do you have to travel at all?

I thought that administratively you handle these cases in your office. I mean, not you but the contractor, and they are supposed to be experts in the field, so why does it take 40 employees to go to the Lake of the Ozarks for a meeting for 2 or 3 days?

I can't see why you have excessive travel and why it is absolutely necessary

Mr. SIMMs. You mean why do Blue Cross plans have travel?
Mr. DUNCAN. All of your contractors.

Mr. Simms. All the intermediaries have to visit the hospitals and nursing homes.

Mr. DUNCAN. Why?
Mr. SIMMs. Periodically for audit, utilization review visits.

They have to monitor the plans, not annually but quarterly sometimes. Even monthly they make these visits. That is part of the reason why some of this travel varies between these plans, even though the dollars may seem the same.

This is spread between the distances between the hospitals.

Mr. DUNCAN. Do you have statistics which would show the percentage of costs per caseload that the various offices handle as far as travel is concerned, the percentage related to travel?

Mr. STEPNICK. We don't.
Mr. DUNCAN. Can you supply that information?

The percentage, for example, let's say, for Blue Cross Dallas or any of them, your figures show the percentage that is related to travel or the cost per case that they handle.

Mr. STEPNICK. I think we can arrange with the Social Security Administration to calculate those figures.

Mr. STARK. Would the gentleman like it just on some of these examples here on the chart?

Mr. DUNCAN. Yes, sir.
Mr. STARK. Thank you very much.

Mr. STEPNICK. In summary, we believe that doubts as to the reasonableness of automobile travel costs charged to medicare would be minimized if the amounts allowable were limited to a specified mileage rate regardless of the type of vehicle used.

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Also, closer adherence by contractors to existing requirements regarding justification of contractor-owned aircraft costs seems necessary, and we plan to scrutinize these costs more closely in future audits.

Mr. Chairman, this concludes my prepared remarks. I would be pleased to answer any questions you or other members of the subcommittee may have.

Mr. Stark. Thank you very much, Ed.

I wonder if in your experiences as an auditor you're not aware that in general the three major private aircraft-Beech, Cessna, and Piper-sell executive aircraft and they rely strongly on the cost effectiveness of those aircraft, taking into consideration such things as the investment tax credit and accelerated depreciation because, without the tax gimmicks, if you will, and assuming at least the 50percent marginal tax bracket, there is very little way with the average use of a large business aircraft you can compare it with either commercial travel and cabs and the hotel or Holiday Inn bills tossed in, that when you have nonprofit tax-exempt organizations they start out way behind in justifying aircraft as it is.

Mr. ŠTEPNICK. I think the most interesting aspect of the comparison between the contractor-owned aircraft and the commercial aircraft is a factor that some of the plans are using to justify the costs of charging the contracts.

The factor is one that is generally allowable under the Federal procurement regulations and it is basically the value of the employee's time.

I wouldn't want to characterize this as a gimmick, but it certainly can be a rather subjective kind of thing.

Mr. STARK. What you are saying, if I can get that right, is that if somebody makes $200,000 a year as a salary, one of the ways you would justify a $700,000 airplane is that the man at $200,000 a year is probably making $259,000 a year straight time.

Therefore, the less time he is in the air the more time he saves the Government. The poor guy slugging along at $50,000 a year really doesn't deserve the airplane because his time isn't so valuable so you get a kind of Catch-22.

Mr. STEPNICK. The higher the salary rate the greater the benefit of owning a privately owned plane.

Mr. STARK. Thank you very much.
Mr. Rangel?

Mr. RANGEL. Who has the responsibility to audit the intermediaries and the carriers in the Federal Government? What agency?

Mr. STEPNICK. The HEW Audit Agency. This is the organization that I represent.

These would be the post-audits of administrative claims. Mr. RANGEL. Why is it that we have examples, as pointed out by Mr. Duncan and Mr. Stark, of whether or not an intermediary should know whether he can take his family and friends to a motel for educational purposes?

Why is it that in all of these years they do not know what they can or cannot do?

Mr. STEPNICK. They have in the past apparently been able to justify those costs as reasonable. While our audits have picked up those items from time to time, under the selective testing techniques

that we have been using, I would have to admit that apparently some have slipped through.

Mr. RANGEL. Excuse me. I do not understand this "some slipped through”.

Mr. STEPNICK. We found it now, but it could have slipped through in prior audits. This is what I am saying.

Mr. RANGEL. I understand, as far as this intermediary is concerned he does not see any wrongdoing. He said that it was an educational meeting at the motel. So, obviously, it did not slip through. He wants his reimbursement.

Mr. STEPNICK. Yes, right.

Mr. RANGEL. My point is, as lawyers, I think we have tried to find out where we can be exempt under the tax code.

Could you tell me just what type of medical education was necessary for the wives and whomever else attended this motel meeting?

Mr. STEPNICK. I believe as to the wives and family, as I recall, the specific justification for this meeting is a number of the attendants were board members whose services were being rendered at great inconvenience to themselves and the plan, and it was felt desirable that their families also not be inconvenienced by their absence.

Mr. STARK. If the gentleman would yield.
If I could take all of us off the hook.

Mr. STEPNICK. Don't misunderstand me. I am not trying to justify it at all. I am telling you this is what the response indicated to us.

Mr. RANGEL. If I could find IRS auditors as kind as you are in understanding what I was trying to do, I would be way ahead.

Mr. STEPNICK. Don't misunderstand me. We have questioned this and we recommend that this cost be disallowed.

Mr. RANGEL. What bothers me is that, generally speaking, we know what we can get away with IRS, and we know what is going to be audited if it does not pass through.

Your attitude does not bother me as much as the fact that in 10 years they have no reason to believe that this type of thing is not justified.

I mean, they are not paying the $2. They are fighting it. It does not bother me that it is one. I just do not know how many others believe that this is a legitimate expense that they can pass over to the Federal Government.

Is there anything in the regulations that cover this type of thing?

Mr. SIMMONS. Sure. I think the thrust of the contractor's argument in this case was that it was a general educational meeting.

Apparently, they had approval from the State insurance commissioner to go outside the State and they took their wives along, what they stated to be the directors, who are not paid, to educate them and explain to them why their husbands had to be away attending these meetings.

Mr. STARK. Did they take the State commissioner with them?

Mr. SIMMONS. I don't have information to indicate they did or did not.

Mr. RANGEL. I think the Congress should think of ways to have wives with us just to show how important it is for them to be with us.

Mr. SIMMS. State insurance commissioners may allow these when they establish their Blue Cross and Blue Shield rates. They think the Federal Government ought to pick it up, too.

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