Federal Reports

As part of our annual audit plan, we performed an audit of costs billed to Tennessee Valley Authority (TVA) by BlueCross BlueShield of Tennessee, Inc. (BCBST) under Contract <br> No. 11022 for medical administrative services. Our objective was to determine if the costs billed to TVA under Contract No. 11022 for medical administrative services were in accordance with the contract's terms. The audit covered claim costs and associated fees totaling $262,707,081 billed to TVA during calendar years (CY) 2017 and 2018.In summary, we determined BCBST overbilled TVA an estimated $88,163, including (1) a net $36,991 related to shared savings for which BCBST has reimbursed TVA a net $18,166, (2) $21,259 for claims that exceeded chiropractic plan limits, (3) an estimated $17,503 in excess costs due to established patients being billed as new patients, and (4) $12,410 in credits not received by TVA.In addition, we found TVA paid from $369,116 to $836,232 more for administrative fees and various services, such as provider audits and other shared saving services, than it would have under TVA's prior contract with BCBST. The additional payments could have occurred because TVA was not aware of a BCBST underwriting guideline regarding the effect of shared savings on administrative fees.(Summary Only)

This report was submitted to the Comptroller General in accordance with Section 5 of the Government Accountability Office Act of 2008. The report summarizes the activities of the Office of Inspector General (OIG) for the six-month reporting period ending March 31, 2020. During the reporting period, the OIG initiated work on three audits designed to assess the effectiveness of GAO operation in three distinct areas. The OIG closed eight investigations and opened 11 new investigations. One significant investigation closed during the reporting period involved falsification of documents by GAO’s maintenance contractor, resulting in a government settlement of almost $300,000, of which GAO received about $230,000 as recompense for its losses. In addition, the OIG processed 79 hotline complaints, many of which were referred to other OIGs for action because the matters involved were within their jurisdictions. The OIG continues to focus on GAO management challenge areas—including human capital management and information technology. The OIG remained active in the GAO and OIG communities by briefing new GAO employees on its audit and investigative missions, and participating in committees and working groups of the Council of Inspectors General on Integrity and Efficiency. Details of these activities and other accomplishments are provided in the report.

The Centers for Medicare & Medicaid Services (CMS) reimburses contractors for a portion of their postretirement benefit (PRB) costs, which are funded by the contributions that contractors make to their dedicated trust fund.

The Centers for Medicare & Medicaid Services (CMS) reimburses contractors for a portion of their pension costs, which are funded by the annual contributions that contractors make to their pension plans.

Medicare contractors are required to separately account for the Medicare segment pension plan assets based on the requirements of Cost Accounting Standards (CAS) 412 and 413.The HHS, OIG, Office of Audit Services, Region VII pension audit team reviews the Medicare segment pension assets to ensure compliance with Federal regulations. Previous OIG audits found that Medicare contractors did not always correctly identify and update the segmented pension assets.

Medicare contractors are required to separately account for the Medicare segment pension plan assets based on the requirements of Cost Accounting Standards (CAS) 412 and 413.The HHS, OIG, Office of Audit Services, Region VII pension audit team reviews the Medicare segment pension assets to ensure compliance with Federal regulations. Previous OIG audits found that Medicare contractors did not always correctly identify and update the segmented pension assets.