Review of Blue Cross Blue Shield Association's Final Administrative Cost Proposals for Fiscal Year 2009

摘要

Title XVIII of the Social Security Act established the Health Insurance for the Aged and Disabled (Medicare) program, which provides for a hospital insurance program (Part A) and a related supplementary medical insurance program (Part B). The Centers for Medicare & Medicaid Services (CMS) administers the Medicare program through contracts with private organizations (contractors). CMS contracts provide for the reimbursement of allowable administrative costs. In claiming costs, contractors must follow cost reimbursement principles contained in the Federal Acquisition Regulation (FAR) and the Medicare contracts. After the close of each fiscal year (FY), contractors submit to CMS a Final Administrative Cost Proposal (FACP) reporting Medicare costs. Once CMS accepts an FACP, the contractor and CMS negotiate a final settlement of allowable administrative costs. For FY 2009, CMS contracted with Blue Cross Blue Shield Association (BCBSA) to serve as a Medicare contractor. BCBSA reported Medicare administrative costs totaling $4,338,335 on its FACP for FY 2009. Our objective was to determine whether the administrative costs that BCBSA claimed on its FACP for FY 2009 were allowable, allocable, and reasonable in accordance with part 31 of the FAR and the Medicare contract.