Most of HealthNow New York, Inc.'s Medicare Part B Severance and Termination Costs Were Allowable.

摘要

Title XVIII of the Social Security Act established the Medicare program. The Centers for Medicare & Medicaid Services (CMS) administers the Medicare program through contractors, including Part B carriers that process and pay Medicare claims. Contracts between CMS and the Medicare contractors define the functions to be performed and provide for the reimbursement of allowable costs incurred in the processing of Medicare claims and allowable termination costs if CMS terminated the contract. In claiming costs, contractors must follow cost reimbursement principles contained in the Federal Acquisition Regulation (FAR) and the Medicare contract. CMS contracted with HealthNow New York, Inc. (HealthNow) to serve as the Medicare Part B carrier for 45 counties in upstate New York. Pursuant to section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, P.L. No. 108-173, CMS replaced Part B contractors with new contract entities called Medicare Administrative Contractors (MAC). CMS did not award HealthNow a MAC contract. As a result, CMS terminated its Part B carrier contract with HealthNow effective September 1, 2008. After CMS terminated its contract with HealthNow, HealthNow submitted Medicare Part B termination cost vouchers to CMS for which it received reimbursement for severance and termination costs totaling $5,357,391 for the period September 1, 2008, through June 30, 2009.