17B:26A-16. Audit required, conditions
265 words·~1 min read·
/nj/title-17b/chapter-26a/17b-26a-16·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
5. a. Whenever the contracting carrier reports a net loss to the commissioner pursuant to paragraph
(2)of subsection a. of section 4 of this act, the related operations of the contracting carrier and any losses incurred by the contracting carrier regarding Medicare supplement insurance policies or contracts issued pursuant to subsection a. of section 3 of this act shall be subject to an audit conducted by a qualified independent certified public accountant prior to the imposition of any assessment pursuant to subsection b. of section 4 of this act.
b. The auditor shall be selected and approved by the governing board of the plan through a competitive bidding process of certified public accountants qualified in New Jersey to perform such audits. The audit shall include:
(1)a review of the handling and accounting of assets and monies of the contracting carrier;
(2)a determination that administrative expenses have been properly allocated and are reasonable;
(3)a review of the internal financial controls of the contracting carrier;
(4)a review of the annual financial report of the contracting carrier; and
(5)a review of the calculation by the commissioner of any assessments for net losses.
c. A copy of the audit and related management letters shall be delivered to the governing board of the plan, to the commissioner and to each carrier and health maintenance organization to which the provisions of this act apply. The audit report shall be reviewed by the governing board of the plan. Upon recommendation of the governing board, the contracting carrier shall implement any recommendations made by the auditor.
L.1995,c.229,s.5.