OIG: Fallon Community Health Plan received an extra $154,970 in MMA funding
Compliance Monitor, February 1, 2006
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The OIG has found that Fallon Community Health Plan of Worcester, MA received $154,970 more than it was legally subsidized under the Medicare Prescription Drug, Improvement and Modernization Act (MMA).
The OIG's audit objective was to determine whether Fallon's use of its MMA payment increases was adequately supported and allowable.
The OIG found that generally, Fallon's use of a $10.9 million MMA payment increase was adequately supported and in accord with MMA requirements.
The exception was that Fallon's estimate of $160,730 for subsidizing its members' drug discount card purchases exceeded actual purchases. As a result, Fallon received $154,970 more than it was subsidized. Fallon did not use these excess funds for other allowable purposes under MMA-instead, the funds were deposited into the corporate accounts.
The OIG recommended that Fallon return the $154,970 or request permission from CMS to use the funds in a manner consistent with MMA.
Fallon concurred with the finding and indicated it would contact CMS.
To perform the audit, the OIG
Click here to read the audit report, "Fallon Community Health Plan's Adjusted Community Rate Proposal Modifications for Contract Year 2004," (A-01-05-00512) issued January 11, 2006.
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