Audit of HealthNow New York, Inc.'s Medicare Part B Final Administrative Cost Proposal for Fiscal Year 2008

摘要

Centers for Medicare & Medicaid Services (CMS) contracts provide for the reimbursement of allowable administrative costs incurred in processing Medicare claims. In claiming costs, contractors must follow cost reimbursement principles contained in the Federal Acquisition Regulation (FAR) and the Medicare contracts. Following the close of each fiscal year (FY), contractors submit to CMS a Final Administrative Cost Proposal (cost proposal), which reports the Medicare administrative costs incurred during the year. The cost proposal and supporting data provide the basis for the CMS contracting officer and contractor to negotiate a final settlement of allowable administrative costs. For FY 2008, CMS contracted with HealthNow New York, Inc. (HealthNow) to serve as the Medicare Part B carrier for 45 counties in upstate New York. For this period, HealthNow reported Medicare Part B administrative costs totaling $15,551,803, which included $850,571 in transition costs. In 2008, CMS awarded a Medicare Administrative Contract for the region covered by HealthNow to National Government Services, Inc. (NGS), resulting in the transition of responsibilities under the Part B contract from HealthNow to NGS on September 1, 2008. Our objectives were to determine whether (1) the HealthNow cost proposal for FY 2008 fairly presented program administration costs and (2) the costs were reasonable, allowable, and allocable in accordance with the FAR and the Medicare contract.