Blue Shield investigation confirms misconduct by employees handling Medicare performance reports.SAN FRANCISCO--(BUSINESS WIRE)--Aug. 16, 1995--Blue Shield of California acknowledged today it has disciplined a number of employees for past misconduct under the company's federal contract as administrator of Medicare Part B medical claims. Eleven employees have received letters of reprimand REPRIMAND, punishment. The censure which in some cases a public office pronounces against an offender. 2. This species of punishment is used by legislative bodies to punish their members or others who have been guilty of some impropriety of conduct towards them. , one employee has been dismissed and two senior managers have resigned from their posts. A total of 400 employees support administration of the Medicare contract. The alleged misconduct involved alteration or inappropriate submission of documents subject to annual performance audits by the Health Care Financing Administration Health Care Financing Administration, n.pr department in the U.S. agency of Health and Human Services responsible for the oversight of the Medicaid and Medicare benefit programs, including guidelines, payment, and coverage policies. (HCFA HCFA abbr. Health Care Financing Administration HCFA, n.pr See Health Care Financing Administration. ). Since learning of the improprieties, Blue Shield Blue Shield A US not-for-profit health care insurer that is a reimbursement intermediary for physicians. Cf Blue Cross. has taken many corrective steps, in addition to the current discipline. An outside consulting firm, expert in Medicare administration, was engaged to review all internal procedures and controls. The consultants made recommendations to tighten and improve the controls and procedures. Thus, Blue Shield has taken steps to ensure against any further improper actions. Under contract with HCFA, Blue Shield serves some 1.3 million Medicare beneficiaries in northern California and Riverside and San Bernardino Counties. Annually, the organization administers payment of about 25 million medical claims totaling over $1.6 billion. Blue Shield's investigation has uncovered no misuse of Medicare Trust Fund dollars nor improper denial or payment of benefits for Medicare beneficiaries. The organization continues to cooperate in an investigation conducted by the Office of Inspector General Noun 1. Office of Inspector General - the investigative arm of the Federal Trade Commission OIG independent agency - an agency of the United States government that is created by an act of Congress and is independent of the executive departments of the Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS . Blue Shield has maintained an excellent service record with HCFA as one of the nation's leading Medicare claims administrators. The company has reduced the cost per claim processed from over $3 in 1966 to $1.27 today. Over the years, Blue Shield has also received special commendation from HCFA for innovations in customer service and data processing technology. CONTACT: Blue Shield of California Blue Shield of California is a not-for-profit health insurance provider headquartered in San Francisco, California. An independent licensee of the Blue Cross and Blue Shield Association, Blue Shield of California is an incorporated, wholly owned subsidiary of California Physicians' , San Francisco Mike Odom, 415/445-5281 |
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