Blue Cross Blue Shield Association Did Not Claim Some Allowable Medicare Postretirement Benefit Costs For Fiscal Years 2002 Through 2010

摘要

Medicare contractors are eligible to be reimbursed a portion of their postretirement benefit (PRB) costs, which are funded by direct payments to beneficiaries or contributions to a dedicated trust fund. The amount of PRB costs that the Centers for Medicare & Medicaid Services (CMS) reimburses to the contractors is determined by the cost reimbursement principles contained in the Federal Acquisition Regulation as required by the Medicare contracts. Previous Office of Inspector General reviews found that Medicare contractors have not always complied with Federal requirements when claiming PRB costs for Medicare reimbursement. For this review, we focused on one Medicare contractor, Blue Cross Blue Shield Association (the Association). In particular, we examined the Medicare segment and Other segment allowable PRB costs (which for this report we will refer to as PRB costs) that the Association claimed for Medicare reimbursement on its Final Administrative Cost Proposals (FACPs). The objective of this review was to determine whether the fiscal years (FYs) 2002 through 2010 PRB costs that the Association claimed for Medicare reimbursement under the provisions of its fiscal intermediary and carrier contracts, and reported on its FACPs, were allowable and correctly claimed.