Specifications include, but are not limited to: Montgomery College’s Internal Audit and Advisory Services Director, along with the Human Resources
office that oversees the College’s healthcare plans, is seeking a firm to perform a statistically valid, riskstratified, random sample Medical Claims Recovery Audit across several provider service types. The audit
will include the following parameters:
• Test period: 2018 claims.
• There are 1,467 participants in the College’s plan with Cigna.
• Approximately $20M was incurred in self-insured medical and prescription costs with Cigna in
• The College maintains self-insured plans with Kaiser and Cigna. The audit scope will include the
Cigna claims only.
• Cigna will permit up to 300 claims.
• Electronic audits are not permitted by Cigna in the College’s agreement.
• The work will be performed on-site at Cigna, where needed, as the College does not maintain the
• Strategy for developing the sample plan must address how risks will be identified, data collected,
and controls assessed.
• The audit will kick-off between June 18 - 24, 2019.