Review of Additional Benefits Reported by PacifiCare of Texas in the Calendar Year 2000 Adjusted Community Rate Proposal for its San Antonio, Texas Plan

EXECUTIVE SUMMARY:

This report provides the results of our review of additional benefits reported by Pacificare of Texas (Pacificare), in the Calendar year (CY) 2000 Adjusted Community Rate Proposal (ACRP) for the San Antonio, Texas plan.  Our review showed that the additional benefits estimated in Pacificare's CY 2000 ACRP were available to Medicare beneficiaries at the levels and co-payments priced in the ACRP, except for additional chiropractic care services. Pacificare estimated $107,355 for additional chiropractic services that were not supported or offered to its members. PacifiCare agreed with our audit results and stated that it (1) revised the ACRP preparation and pricing methodology to ensure that only additional benefits available to Medicare beneficiaries are included in the ACRP; (2) examines the accounting system and supporting documentation annually to ensure that appropriate detail data is available for all material Medicare benefits; and (3) monitors the controls for maintaining copies of all provider contracts.