OIG delivers clean audit to California healthcare network
Compliance Monitor, December 14, 2005
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Health Net of Woodland Hills, CA has received a clean audit from the OIG.
The OIG's objective in the audit was to determine whether the Medicare Advantage organization (MAO) contractor correctly used its Medicare Prescription Drug, Improvement, and Modernization Act (MMA) payment increase.
Under Part C of the Medicare program, MAOs are responsible for providing all Medicare-covered services, except hospice care, in return for a predetermined capitated payment. The MMA provided increased capitation payments to MAOs effective March 1, 2004.
The OIG found that Health Net's use of its MMA payment increase of $5.6 million was allowable and adequately supported under the MMA. Specifically, Health Net used the increased MMA payments to reduce beneficiary cost sharing, enhance benefits, and stabilize beneficiary access to providers.
The OIG made no recommendations.
To perform the audit, the OIG
Click here to read the audit report, "Review of Health Net of California's Modifications to Its 2004 Adjusted Community Rate Proposal Under the Medicare Prescription Drug, Improvement, and Modernization Act," (A-09-05-00056) issued November 16, 2005.
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