Report Materials
This final report summarizes the results of our reviews, made at the request of the Centers for Medicare & Medicaid Services (CMS), of 186 adjusted community rate proposals (ACRPs) submitted by 55 Medicare+Choice (M+C) organizations for Contract Year 2000. In general, we found that: 49 percent of the ACRPs were not prepared in accordance with CMS' instructions; 66 percent contained errors that affected at least one of the three components of the adjusted community rate (direct medical care, administration, or additional revenues); and 36 percent overstated the beneficiary premium/cost sharing amounts and/or did not provide additional benefits. We were unable to determine an overall dollar effect of the miscalculated ACRPs, however, there could have been a significant impact on (1) payments made by the M+C organizations to their providers, (2) out-of-pocket expenses of the beneficiaries, and (3) amount of profit earned by the M+C organizations. Among other things, we recommended that CMS (1) reiterate to M+C organizations the importance of following CMS' instructions in preparing the ACRPs, (2) work with the M+C organizations to have them develop corrective actions to address the deficiencies noted in our audits to ensure that future ACRP submissions are correct, and (3) perform follow-up evaluations of such actions. The CMS generally concurred with our recommendations.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.