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Department of Health and Human Services

Office of Inspector General -- AUDIT

"2004 Adjusted Community Rate Proposal Modifications Submitted As a Result of the Medicare Prescription Drug, Improvement, and Modernization Act," (A-04-05-06008)

December 21, 2005

Complete Text of Report is available in PDF format (567 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


The objective of our review was to determine whether Vista Healthplan of South Florida, Inc.’s (Vista’s) use of its Medicare Prescription Drug, Improvement, and Modernization Act (MMA) payment increase was adequately supported and allowable.  Vista submitted a revised proposal for contract year 2004 that reflected an increase of $10.7 million in Medicare capitation payments that were provided by the MMA legislation.  Vista appropriately used the MMA payment increase to stabilize and enhance beneficiary access to providers through increased provider payments.  The increased payments resulted when Vista revised many provider contracts to include higher compensation percentages.  Vista’s increased provider payments were adequately supported and allowable.  Therefore, we did not make any recommendations.