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NCJ Number: 63842 Add to Shopping cart Find in a Library
Title: CIVIL SERVICE SHOULD AUDIT KAISER PLANS' PREMIUM RATES UNDER THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM TO PROTECT THE GOVERNMENT
Author(s): ANON
Corporate Author: US Government Accountability Office
United States of America
Date Published: 1978
Page Count: 30
Sponsoring Agency: National Technical Information Service
Springfield, VA 22151
US Government Accountability Office
Washington, DC 20548
Sale Source: National Technical Information Service
US Dept of Commerce
5285 Port Royal Road
Springfield, VA 22151
United States of America
Language: English
Country: United States of America
Annotation: THE CIVIL SERVICE COMMISSION (CSC) NEEDS TO DEVELOP EVALUATION CRITERIA FOR THE KAISER HEALTH PLAN RATES AND TO MAKE COMPREHENSIVE AUDITS OF THE PLANS FOR NORTHERN AND SOUTHERN CALIFORNIA.
Abstract: THE FEDERAL EMPLOYEES HEALTH BENEFITS ACT REQUIRES THAT RATES CHARGED UNDER HEALTH PLAN CONTRACTS REFLECT, REASONABLY AND EQUITABLY, THE COST OF BENEFITS PROVIDED. FOR THE KAISER HEALTH PLANS OF NORTHERN AND SOUTHERN CALIFORNIA, THE CSC HAS NOT DETERMINED WHETHER THIS REQUIREMENT HAS BEEN MET. SINCE A SMALL ERROR CAN SIGNIFICANTLY INCREASE GOVERNMENT COST, THE COMMISSION MUST DETERMINE WHETHER THE TWO RATES ARE REASONABLE AND EQUITABLE. LIMITED AUDITING OF THE PLANS HAS BEEN UNSATISFACTORY BECAUSE NO EVALUATION CRITERIA EXIST. THE COMMISSION SHOULD (1) DEVELOP CRITERIA TO EVALUATE THE REASONABLENESS AND EQUITY OF RATES OF COMMUNITY-RATED, COMPREHENSIVE HEALTH PLANS LIKE THE KAISERS AND (2) COMPREHENSIVELY AUDIT THE CALIFORNIA KAISER PLANS. THE AUDITS SHOULD INCLUDE AN EVALUATION OF KAISER'S PRACTICES OF CONSISTENTLY UNDERESTIMATING THE EARNINGS EXPECTED FROM APPLYING PREMIUM RATES; HAVING DIFFERENT CONTRACT RENEWAL DATES, BUT CONSTANT PREMIUM RATES, FOR ALL MEMBER GROUPS; AND ALLOWING FOR LONG-TERM CAPITAL NEEDS. ADDITIONALLY, THE COMMISSION SHOULD DEVELOP A FINANCIAL REPORTING FORMAT FORCING FULL DISCLOSURE OF OPERATIONS RESULTS FOR ALL HEALTH PLANS COMPONENTS ORGANIZED LIKE KAISER. APPENDIXES PROVIDE SUMMARIES OF RATEMAKING FORECASTS WHEN COMPARED TO ACTUAL RESULTS OF OPERATION, 1972-76, FOR BOTH THE SOUTHERN AND THE NORTHERN CALIFORNIA PLAN. (MHP)
Index Term(s): Accountability; Allocution; Evaluation; Evaluation criteria; Federal programs; Government contracting
To cite this abstract, use the following link:
http://www.ncjrs.gov/App/publications/abstract.aspx?ID=63842

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