Review of Medicare Part B Administrative Costs Fiscal Years 1995 - 1997, Highmark, Inc., Camp Hill, Pennsylvania

EXECUTIVE SUMMARY:

This final report covers the audit of $299,169,893 in Medicare Part B administrative costs claimed by Highmark, Inc, d/b/a HGSAdministrators for the period October 1, 1994 through September 30, 1997.  We identified and recommended for adjustment $1,224,793 in costs that were either unallowable, unreasonable, or unapproved.  We also questioned $640,123 in unsupported costs for which documentation supporting the expense was either not provided or proved inadequate to determine the nature, type, reasonableness or necessity of the expense.  The auditors did not render an opinion on reported Medigap credits totaling $478,418 because of the significant amount of unsupported billings.