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Medicare Advantage and Prescription Drug Program

Medicare Advantage and Prescription Drug Program

PHBV Partners has a working knowledge of industry practices related to complex health plans including such issues as understanding the complex organizational and operating structures employed by the large affiliated group corporations that are typical to the industry, industry practices related to the application of administrative overhead rates and reporting of affiliate transactions.

We have audited large (revenues in excess of $100 million), complex health plans in several states and on behalf of CMS where we have identified significant financial issues including non-compliance with FAR, the misallocation and inclusion of unallowable administrative costs, management fees, royalty licensing fees, and lobbying expenses, inappropriate accruals and reserves, misstating of member months, as well as the identification of inappropriate related-party transactions and costs. Our experience also includes compliance audits of Pharmacy Benefit Managers (PBMs) and Third Party Administrators (TPAs).