Skip Navigation Change Font Size

Audit (A-01-12-00011)

04-03-2013
Rhode Island's Managed Care Contract Settlements With Neighborhood Health Plan of Rhode Island Did Not Always Comply With Federal and State Requirements

Complete Report

Download the complete report

Adobe® Acrobat® is required to read PDF files.

Summary

The Rhode Island Executive Office of Health and Human Services, Department of Human Services (State agency), did not always make managed care contract settlements in accordance with Federal and State requirements. Specifically, the State agency did not always determine the managed care contract settlements in accordance with the terms of its contract with Neighborhood Health Plan of Rhode Island (Neighborhood). In addition, the State agency did not consistently follow its policies and procedures regarding the calculation of the final contract settlement amounts and the reporting requirements for Neighborhood. Accordingly, we do not have reasonable assurance that (1) the State agency has refunded the Federal share of all contract settlements due from Neighborhood, (2) the contract settlements were calculated using consistent and reliable capitation payment data, and (3) the contract settlements were calculated using accurate medical expense data.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

I'm Looking For

Let's start by choosing a topic

Exclusions Database Report Fraud
Newsletter Sign Up Envelop Graphic

Stay up to date on the latest OIG news and opinions

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201