The Health Plan accurately reported its STAR Kids medical (fee-for-service) expenses totaling $435.6 million on its fiscal year 2018 FSRs and in its
encounter data submitted to the Commission. However, the Health Plan should strengthen controls to ensure that it pays provider claims accurately.
In addition, the Health Plan did not have a documented process to periodically evaluate its compliance with the Commission's fair market value
reporting requirements for affiliate provider claims.
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