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Department of Health and Human Services

Office of Inspector General -- AUDIT

"Audit of Medicare Contractor's Segmented Pension Cost, Blue Cross and Blue Shield of Texas, Inc.," (A-07-91-00472)

January 31, 1992

Complete Text of Report is available in PDF format (574 KB). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


This final report provides the results of our audit of Blue Cross and Blue Shield of Texas, Inc.'s (Texas) implementation of its Medicare contract clause on pension plan segmentation. Texas identified four Medicare segments in 1981 using cost centers instead of responsible organizational units specified in the contract. Texas' identification methodology understated the actuarial liability fraction. When applied to the 1986 pension assets, Texas' fraction understated Medicare's pension assets as of 1986 by $552,870. We recommended that Medicare's segmented assets be increased by $552,870. Medicare's pension assets were understated by another $880,874 in the updating of Medicare's segmented assets from 1986 to 1990. The understatement occurred because Texas incorrectly identified the Medicare segments and had not adjusted for participant transfers in and out of the Medicare segments after 1986. We recommended that Texas increase pension assets of the Medicare segments by an additional $880,874. Texas generally agreed with our recommendations. The Health Care Financing Administration also agreed with our findings and recommendations.