Review of Managed Care Additional Benefits at Ochsner Health Plan of Louisiana for Contract Year 2000

EXECUTIVE SUMMARY:

The objective of this audit was to assess whether additional benefits proposed in Ochsner's Contract Year (CY) 2000 adjusted community rate proposal (ACRP) were available to Medicare beneficiaries as advertised and were comparable to costs actually incurred, and whether the actual additional benefits were properly valued.  Our review showed that, during 2000, Ochsner provided the additional benefits proposed in its CY 2000 ACRP.  However, we found that Ochsner distributed the incorrect prescription drug formulary guide to its Medicare enrollees, resulting in overpayment of prescription drug copayments totaling $4,281 by 104 enrollees.  Ochsner told us that they are refunding those overpayments.