Contract for the Administration of TVA Dental Benefit Plan

We audited $25 million of costs billed to TVA by a contractor from January 1, 2006, through December 31, 2008, for the administration of TVA's dental benefit plan. Our objective was to determine if the costs billed to TVA were in compliance with the contract terms and conditions. In summary, we found TVA had been overbilled $25,591, including: (1) $17,713 for duplicate claim payments; (2) $832 for claims which exceeded plan limits; and (3) $7,046 for ineligible orthodontic payments. In addition, due to the high amount ($132,000) of additional coinsurance that was billable to members during our audit period, we determined the "Alternative Benefits" provision in the dental benefit plan might be unclear as it relates to the member's responsibility when alternative procedures are used. We recommended TVA management (1) recover $25,591 in overbilled costs from the contractor, and (2) revise the dental benefit plan to more clearly define the member's responsibility as it relates to alternative procedures The contractor and TVA management agreed TVA had been overbilled $25,591. In addition, TVA management agreed to consider revising the dental benefit plan to clearly define the member's responsibility as it relates to alternative procedures. Summary Only