We also identified entertainment costs, charitable contributions, lobbying costs, related party transactions and reinsurance costs that would be considered inappropriate and unallowable if existing Medicare regulations, applicable to other parts of the Medicare program, were applied to risk-based MCOs. The methodology which allows MCOs to apportion administrative costs to Medicare is flawed and results in Medicare covering a disproportionate amount of the MCO's administrative costs.
Additional reviews are ongoing and preliminary results show similar problems at other MCOs.
The results of these reviews are being shared with the Health Care Health Financing Administration so that appropriate legislative changes can be considered.