| 1 |
No |
$0 |
$437,982 |
|
|
We recommend that the contracting officer disallow $437,982 in overcharges to the FEHBP. To date, overpayments totaling $64,461 have been recovered, leaving a remaining amount of $373,521 due to the FEHBP.
|
| 2 |
No |
$0 |
$7,166,608 |
|
|
We recommend that the contracting officer disallow $7,166,608 in overcharges to the FEHBP. To date, overpayments totaling $1,305,776 have been recovered, leaving a remaining amount of $5,860,832 due to the FEHBP.
|
| 3 |
No |
$0 |
$0 |
|
|
We recommend that the contracting officer allow $96,784 in underpayments to the FEHBP and direct the Association to instruct the local BCBS Plans to make the necessary adjustments and issue payments to the providers and/or members.
|
| 4 |
No |
$0 |
$0 |
|
|
We recommend that the contracting officer ensure that the Association continues recovery efforts and that the FEHBP is properly credited for all FY 2022 monies recovered for the nine months of FY 2022 not covered by this audit.
|
| 5 |
No |
$0 |
$5,509,432 |
|
|
We recommend that the contracting officer disallow $5,509,432 in overcharges to the FEHBP. To date, overpayments totaling $2,266,366 have been recovered, leaving a remaining amount of $3,243,066 due to the FEHBP.
|
| 6 |
No |
$0 |
$0 |
|
|
We recommend that the contracting officer direct the Association to institute policies and procedures to run reports of claims with the X52 errors within 30 days of any software update effecting pricing, to issue to its local BCBS Plans for review and repricing.
|
| 7 |
No |
$0 |
$9,464,843 |
|
|
We recommend that the contracting officer disallow $9,464,843 in overpayments estimated from our expanded sample. In addition, we recommend the contracting officer direct the Association to complete its review of the expanded sample and the appropriate amounts to be paid to determine the actual overpayment to the FEHBP.
|
| 8 |
No |
$0 |
$340,079 |
|
|
We recommend that the contracting officer disallow $340,079 in overcharges to the FEHBP.
|
| 9 |
No |
$0 |
$0 |
|
|
We recommend that the contracting officer direct the Association to update its FAM to instruct local BCBS Plans to manually price claim lines with modifiers requiring medical review/approval at the appropriate Medicare amount with applicable modifier price adjustments.
|
| 10 |
No |
$0 |
$0 |
|
|
We recommend the contracting officer direct the Association to consider requiring its OBRA vendor to return a price for all claims initially, even if the claims require medical review/approval, to ensure that a price is available following the review.
|
| 11 |
No |
$0 |
$34,045 |
|
|
We recommend that the contracting officer disallow $34,045 in overcharges to the FEHBP.
|
