Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Health Net of California's Modifications to Its 2004 Adjusted Community Rate Proposal Under the Medicare Prescription Drug, Improvement, and Modernization Act," (A-09-05-00056)

November 16, 2005


Complete Text of Report is available in PDF format (839 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

Our objective was to determine whether Health Netís use of its Medicare Prescription Drug, Improvement, and Modernization Act (MMA) payment increase was allowable and adequately supported under the MMA. Health Netís use of its MMA payment increase of $5.6 million (or $42.88 per-member per-month) was allowable and adequately supported under the MMA.  Specifically, Health Net used the increased MMA payments to reduce beneficiary cost sharing, enhance benefits, and stabilize beneficiary access to providers.  Therefore, we are not making any recommendations to Health Net.