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Response to RFP No. MED13002 State of West Virginia ... - DHHR

Response to RFP No. MED13002 State of West Virginia ... - DHHR

Request For Proposal #

Request For Proposal # MED13002 Recovery Audit Contract – Pharmacy West Virginia Health and Human Services Sagebrush Solutions: Audits of Early Retiree Reinsurance Program (ERRP) Name of customer and agency: Centers for Medicare and Medicaid Services Contract: 500‐01‐0045, etc. Contract value: Approximately $300,000 Performance period: 9/2011 – present Contract type: Time & Expense Technical representative: Steven Keenan Address: 7501 Wisconsin Avenue Bethesda, MD Phone number: (301) 492‐4203 E‐mail:steven.keenan@cms.hhs.gov Sagebrush Program Manager: Sally Reaves Key Project Staff: Andrew Perry, Tariq Shaikh, Sally Reaves Project Description/Relevance to the Sources Sought Criteria: The project requires review of medical and pharmacy claims submitted to the Federal government under the ERRP program. The program subsidizes the health care expenses between $15,000 and $90,000 for early retirees of qualifying employer plans. The employer plans are self‐insured and typically administered by a third‐party. Sagebrush is a subcontractor to David‐James and is responsible for sample design and medical and pharmacy claims testing. Sagebrush Solutions: Annual Audit of Health Care Benefit Plans Name of customer and agency: Teacher Retirement System of Texas Contract: Annual Audit Contract value: $150,000 (2009/2010) and $520,000 (current) Performance period: 10/2009 – 9/2015 Technical representative: Edward Esquivel Address: 1000 Red River Street, Austin, TX 78701 Phone number: (512) 542‐6711 E‐mail: eesquivel@trs.state.tx.us Contract type: Fixed Fee POC: Bob Jordan Address: 1000 Red River Street, Austin, TX 78701 Phone number: (512) 542‐6735 E‐mail: bob.jordan@trs.state.tx.us Sagebrush Program Manager: Sally Reaves Key Project Staff: Andrew Perry, Eva Stogsdill, Sally Reaves Project Description/Relevance to the Sources Sought Criteria: Sagebrush conducts annual audits of the vendors administering the TRS health care benefit plans. TRS self‐insures, providing health care benefits to more than one‐half million actives and retirees and their dependents. The project required review of financial controls and records, including medical claims and supporting records. The auditors accepted 23

Request For Proposal # MED13002 Recovery Audit Contract – Pharmacy West Virginia Health and Human Services financial and transactional data from the plans; conducted electronic tests for financial controls on the data; designed a sampling plan and selected medical and pharmacy claims and medical records for testing. Sagebrush extrapolated any identified misstatement to the reported costs. Sagebrush has audited pharmacy plans administered by Medco and by Caremark on the TRS’ behalf. Sagebrush Solutions: Bi‐Annual Audit of Health Care Benefit Plans Name of customer and agency: ERCOT Contract: Annual Audit Contract value: $38,000 (2008) and $38,000 (2010) Performance period: 2008 and 2010 Technical representative: Debbie McDonough Address: 7620 Metro Center Drive, Austin, TX 78744 Phone number: (512) 225‐7179 E‐mail: dmcdonough@ercot.com Contract type: Fixed Fee POC: Lea Anne Porter Address: no longer with ERCOT Phone number: (512) 426‐6038 (current) E‐mail: lporter@expertbenefitsllc.com (current) Sagebrush Program Manager: Sally Reaves Key Project Staff: Darlene Wojnarowski, Sally Reaves Project Description/Relevance to the Sources Sought Criteria: ERCOT manages the Texas electrical grid. Sagebrush conducted bi‐annual audits of the vendor (CIGNA) administering the self‐insured ERCOT medical and pharmacy plans. The project required review of financial controls and records, including medical and pharmacy claims and supporting records. The auditors accepted financial and transactional data from the plans; conducted electronic tests for financial controls on the data; designed a sampling plan and selected claims and medical records for testing. Sagebrush extrapolated any identified misstatement to the reported costs. 24

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