Broward County Commission Regular Meeting
Director's Name: Bob Melton
Department: County Auditor
Information
Requested Action
title
MOTION TO ACKNOWLEDGE AND FILE Office of the County Auditor’s Interim Report on the Review of United Healthcare Services, Inc. Pharmacy Claims for Broward County - Report No. 26-04.
body
Why Action is Necessary
What Action Accomplishes
Goal Related Icon(s)
☐County Commission
☐Go Green
☐MAP Broward
Previous Action Taken
Summary Explanation/Background
Based on the unique and complex nature of medical and pharmacy claims benefits administration and invoicing practices, we engaged the services of an experienced and specialized third party auditor, TFG Partners, LLC (TFG) to conduct a review of the Agreement Between Broward County and United Healthcare Services, Inc. for Administrative Management Services for Self-Insured Group Health Insurance Coverage and Benefits and Pharmacy Benefit Management Services for Broward County Benefits-Eligible Individuals (RFP #TEC2122482P1).
The objectives of the review were to verify all claims were correctly adjudicated and contractual compliance of other requirements and services provided by United Healthcare Services, Inc. (UHC) for pharmacy claims processed as part of plan year 2022, and through the second quarter of 2023.
With the exceptions of the issues regarding payment of contractual guarantees detailed in this Report, TFG has concluded that plan benefits were implemented in a manner consistent with the Agreement, and there was a high level of compliance between the terms of rebate manufacturer contracts and rebates invoiced on behalf of Broward County.
We appreciate the cooperation and assistance provided by the Human Resources Division and the County Attorney’s Office throughout the review process.
Source of Additional Information
Fiscal Impact
Fiscal Impact/Cost Summary
None.