08/16/07 GAO Reports Medicare’s Health Plan Audits Are Deficient

[admin]

"Audits to assure that private health plans in the Medicare program are delivering all the benefits they are supposed to are too few and too tardy to be of much value, the Government Accountability Office has concluded. The Centers for Medicare and Medicaid Services should increase the frequency of those audits, speed them up to allow benefits to be provided as promised and pursue financial recovery from plans that provide too few benefits, the study found. CMS is required each year to audit one-third of the bids filed by managed care plans to offer benefits to Medicare beneficiaries. Those filings state which benefits will be provided and estimate their cost. To the degree the bids fall below Medicare payment benchmarks, plans must provide more benefits or lower beneficiary costs for premiums or co-payments. If they exceed the benchmarks, the plan must charge plan beneficiaries higher premiums to recover the sums above the benchmark. GAO said CMS generally agreed with its recommendations."

For more information:
http://public.cq.com/docs/hb/hbnews110-000002571345.html