Submitting OIG:
Report Description:
The Patient Protection and Affordable Care Act (ACA) established standards for the amount of premium revenue that certain commercial health insurers and Medicare Advantage plans can spend on costs other than healthcare-related expenses. These standards are known as the medical loss ratio (MLR). Insurers that do not meet these standards must pay rebates to their enrollees or the Department of Health and Human Services. Although the MLR standards do not apply to Medicaid spending, some States have applied similar standards to their contracts with Medicaid managed care organizations. The Federal Government is entitled to the Federal share of the net amount recovered by a State with respect to its Medicaid program.
Date Issued:
Tuesday, October 20, 2015
Agency Reviewed / Investigated:
Submitting OIG-Specific Report Number:
A-02-13-01036
Component, if applicable:
Centers for Medicare & Medicaid Services
Location(s):
NY
United StatesType of Report:
Audit
Questioned Costs:
$0
Funds for Better Use:
$38,471,229
Number of Recommendations:
1
View Document:
Attachment | Size |
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![]() | 1.84 MB |
Additional Details Link: