UnitedHealthcare Dental’s Financial Statistical Reports
Learn how the AI-generated research projects were createdOverall Conclusion
UnitedHealthcare Dental had a process for preparing and reviewing FSRs; however, internal controls were not always effective and allowed for reporting errors, which resulted in overstating reported expenses by $799,351.
Source Document
Audit Scope
The audit scope covered administrative, quality improvement, and pre-implementation expenses during the period from October 29, 2019, through August 31, 2022.
Key Findings Summary
Overstated reported expenses by $799,351 on UnitedHealthcare Dental’s 2021 and 2022 FSRs and pre-implementation expense report due to internal control weaknesses and errors across nine categories.
Did not establish fair market value for affiliate expenses totaling $9,717 reported on 2021 FSR and pre-implementation expense report.
Incorrectly categorized $9,002,010 in expenses across 2021 and 2022 FSRs, with misclassification across line items such as marketing and other administrative expenses; resulting in misstatement of expenses.
AI-Assisted
AI Scope Summary
This audit evaluated whether UnitedHealthcare Dental reported expenses on its FSRs in accordance with applicable requirements and whether it had effective internal controls over FSR preparation, covering administrative, quality improvement, and pre-implementation expenses from October 29, 2019, through August 31, 2022. It concluded with misstated expenses totaling $799,351 due to control weaknesses, including unaffirmed affiliate fair market value and miscategorized costs, informing recommendations to strengthen cost reporting and adherence to program manuals for future audits.
AI-Generated Insight
The audit highlights risks in Medicaid/CHIP financial reporting related to affiliate expense valuation and expense category mappings. Strengthening internal controls and fair market value determinations will improve accuracy of capitation data and rebate calculations in future audits.
Audit Objectives
Determine whether UnitedHealthcare Dental reported expenses on its FSRs in accordance with applicable requirements and whether it designed and implemented effective internal controls over the preparation of its FSRs.
Audit Findings (3)
Overstated reported expenses by $799,351 on UnitedHealthcare Dental’s 2021 and 2022 FSRs and pre-implementation expense report due to internal control weaknesses and errors across nine categories.
Did not establish fair market value for affiliate expenses totaling $9,717 reported on 2021 FSR and pre-implementation expense report.
Incorrectly categorized $9,002,010 in expenses across 2021 and 2022 FSRs, with misclassification across line items such as marketing and other administrative expenses; resulting in misstatement of expenses.
Recommendations (4)
Strengthen FSR preparation and review procedures to ensure expenses are accurate, allowable, complete, and reported in the correct period and comply with reporting requirements.
Implement a process to report affiliate expenses at the affiliate’s actual cost or establish fair market value for those expenses.
Communicate with FRAC to determine the impact of not establishing fair market value for identified affiliates.
Implement a process to report expenses on FSRs based on the type of expense (expense categorization by type).