Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Regence HMO Oregon's Modifications to Its 2001 Adjusted Community Rate Proposal Under the Benefits Improvement and Protection Act of 2000," (A-10-03-00011)

April 26, 2005


Complete Text of Report is available in PDF format (480 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

Our objectives were to determine whether Regence supported modifications to its 2001 adjusted community rate proposal under the Benefits Improvement and Protection Act (BIPA) of 2000 and used the additional capitation payments in a manner consistent with BIPA requirements.  Of the capitation payment increase in Regenceís revised proposal, about $15.4 million was supported in the proposalís modifications and was used in a manner consistent with BIPA requirements.  However, we found (1) Regence did not provide adequate support for approximately $6.8 million in increased payments in the proposalís modifications and we could not determine how much of the amount was used in a manner consistent with BIPA requirements and (2) about $0.5 million was supported in the proposalís modifications but not used in a manner consistent with BIPA requirements.  We recommended that Regence (1) work with CMS to determine what portion of the about $6.8 million in increased payments was not used in a manner consistent with BIPA requirements and refund that amount to the Federal Government (2) refund the about $0.5 million to the Federal Government that was not used in a manner consistent with BIPA and (3) ensure that all estimated costs in future proposals are properly supported and used in a manner consistent with Federal requirements.  Regence did not concur with our findings and recommendations.