The Center for Consumer Information & Insurance Oversight

High-Cost Risk Pool (HCRP) Audits

Section 1343 of the Patient Protection and Affordable Care Act (ACA) established the permanent risk adjustment program, one of the three premium stabilization programs, to provide payments to health insurance issuers that cover higher-cost and higher-risk populations to more evenly spread the financial risk borne by issuers of risk adjustment covered plans and help stabilize premiums. CMS established the high-cost risk pool (HCRP) as part of the Department of Health and Human Services (HHS)-operated risk adjustment methodology beginning with the 2018 benefit year (81 FR 94058 (Jan. 17, 2017)). CMS is responsible for operating the risk adjustment program in any state that does not elect to operate a risk adjustment program.
45 C.F.R. § 153.620(c) authorizes HHS or its designee to audit or conduct a compliance review of an issuer with the applicable federal requirements related to the HHS-operated risk adjustment program (including the HCRP).

HCRP Audit Reports

The HCRP Audits commenced in 2021 with review of data reported by issuers to support the HCRP payments for the 2018 benefit year data submission. This page contains HCRP Audit reports and is organized in alphabetical order by audit benefit year. Reports will be uploaded as each audit benefit year’s review is completed.

HCRP Audit Reports by Reporting Year 

Benefit Year 2018
•    Alliant Health Plans (PDF)
•    AmeriHealth Ins. Company of New Jersey (AmeriHealth) (PDF)
•    Anthem Health Plans, Inc. (Anthem BCBS) (PDF)
•    Anthem Health Plans of VA (Anthem BCBS) (PDF)
•    Anthem Insurance Companies, Inc. (Anthem BCBS) (PDF)
•    BCBSMN INC (BCBSMN) (PDF)
•    Blue Cross & Blue Shield of Rhode Island (BCBSRI) (PDF)
•    Blue Cross and Blue Shield of Alabama (BCBS of AL) (PDF)
•    Blue Cross and Blue Shield of GA, Inc. (BCBS of GA) (PDF)
•    Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. (PDF)
•    Blue Cross and Blue Shield of South Carolina (PDF)
•    Blue Cross Blue Shield of FL, Inc. (BCBS of FL) (PDF)
•    Blue Cross Blue Shield of Illinois (BCBS of IL) (PDF)
•    Blue Cross Blue Shield of Michigan Mutual Insurance Company (BCBS of MI) (PDF)
•    Blue Cross Blue Shield of North Carolina (BCBS of NC) (PDF)
•    Blue Cross Blue Shield of Oklahoma (BCBS of OK) (PDF)
•    Blue Cross Blue Shield of Oregon (Regence) (PDF)
•    Blue Cross Blue Shield of Tennessee (BCBSTN) (PDF)
•    Blue Cross Blue Shield of Texas (BCBS of TX) (PDF)
•    Blue Cross of California (Anthem BCBS) (PDF)
•    CA Physician's Service dba Blue Shield of CA (CA Physician’s BSCA) (PDF)
•    CareSource (PDF)
•    Celtic Insurance Company, FL (Celtic) (PDF)
•    Celtic Insurance Company, MO (Celtic) (PDF)
•    Cigna Health and Life Insurance Company (Cigna) (PDF)
•    Common Ground Healthcare Cooperative (CGHC) (PDF)
•    Empire HealthChoice Assurance, Inc. (Empire) (PDF)
•    Excellus Health Plan, Inc. (Excellus) (PDF)
•    Health Net Life Insurance Company, CA (Health Net) (PDF)
•    Health Net of California, Inc. (Health Net) (PDF)
•    Health Options, Inc. (PDF)
•    Health Plan of Nevada, Inc. (PDF)
•    HealthPartners, Inc (PDF)
•    Highmark, Inc. (PDF)
•    HMO Colorado Inc (Anthem BCBS) (PDF)
•    Horizon Healthcare Services, Inc. (Horizon) (PDF)
•    Humana Employers Health Plan of Georgia, Inc. (Humana) (PDF)
•    Independence Blue Cross (QCC Ins. Co.) (Independence BC) (PDF)
•    Kaiser Foundation Health Plan of Colorado (Kaiser CO) (PDF)
•    Kaiser Foundation Health Plan of Georgia, Inc. (Kaiser GA) (PDF)
•    Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Kaiser Mid-Atl) (PDF)
•    Kaiser Foundation Health Plan of Washington (Kaiser WA) (PDF)
•    Kaiser Foundation Health Plan, Inc. (PDF)
•    Keystone Health Plan East  (PDF)
•    Louisiana Health Service & Indemnity Company (BCBSLA) (PDF)
•    Medica Insurance Company (Medica) (PDF)
•    Moda Health Plan, Inc. (Moda) (PDF)
•    Optima Health (PDF)
•    Oscar Insurance Company of Texas (Oscar) (PDF)
•    Oxford Health Insurance, Inc. (Oxford) (PDF)
•    Premera Blue Cross (PDF)
•    Premera Blue Cross (PDF)
•    Providence Health Plan (PDF)
•    Rocky Mountain Hospital & Medical Service, Inc. (Anthem BCBS) (PDF)
•    Sutter Health Plan (PDF)
•    UCare Minnesota (UCare) (PDF)
•    UHC of California (PDF)
•    UnitedHealthcare Insurance Company (PDF)
•    UnitedHealthcare Insurance Company (PDF)
•    UnitedHealthcare Insurance Company (PDF)
•    UnitedHealthcare Insurance Company (PDF)
•    UPMC Health Options (PDF)
•    Western Health Advantage (PDF)

Benefit Year 2019

•    Ambetter of Peach State – HIOS 70893 (PDF)
•    AmeriHealth Ins Company of New Jersey – HIOS 91762 (PDF)
•    Anthem Health Plans Inc (Anthem BCBS) – HIOS 86545 (PDF)
•    Anthem Health Plans of VA (Anthem BCBS) – HIOS 16064 (PDF)
•    Anthem Ins Companies Inc (Anthem BCBS) – HIOS 17575 (PDF)
•    AvMed, Inc – HIOS 19898 (PDF)
•    BCBS of Texas – HIOS 33602 (PDF)
•    BCBSMN INC – HIOS 49316 (PDF)
•    Blue Cross and Blue Shield of Alabama – HIOS 46944 (PDF)
•    Blue Cross and Blue Shield of GA, Inc – HIOS 49046 (PDF)
•    Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. – HIOS 42690 (PDF)
•    Blue Cross and Blue Shield of South Carolina – HIOS 26065 (PDF)
•    Blue Cross Blue Shield of FL Inc. – HIOS 16842 (PDF)
•    Blue Cross Blue Shield of Illinois – HIOS 36096 (PDF)
•    Blue Cross Blue Shield of Michigan Mutual Insurance Company – HIOS 15560 (PDF)
•    Blue Cross Blue Shield of North Carolina – HIOS 11512 (PDF)
•    Blue Cross Blue Shield of Oklahoma – HIOS 87571 (PDF)
•    Blue Cross of California (Anthem BC) – HIOS 27603 (PDF)
•    BlueCross BlueShield of Tennessee – HIOS 14002 (PDF)
•    CA Physician's Service dba Blue Shield of CA – HIOS 70285 (PDF)
•    Capital Advantage Assurance Company – HIOS 45127 (PDF)
•    CareFirst of Maryland – HIOS 45532 (PDF)
•    CareSource – HIOS 77552 (PDF)
•    Celtic Insurance Company (TX) – HIOS 29418 (PDF)
•    Celtic Insurance Company (IN) – HIOS 76179 (PDF)
•    Celtic Insurance Company (MO) – HIOS 99723 (PDF)
•    Common Ground Healthcare Cooperative – HIOS 87416 (PDF)
•    Community Health Choice, Inc. – HIOS 27248 (PDF)
•    Empire HealthChoice Assurance, Inc. – HIOS 44113 (PDF)
•    Group Health Plan Inc – HIOS 34102 (PDF)
•    Harvard Pilgrim Health Care Inc. – HIOS 36046 (PDF)
•    Hawaii Medical Service Association – HIOS 18350 (PDF)
•    Health First Commercial Plans, Inc. – HIOS 36194 (PDF)
•    Health Net Life Insurance Company – HIOS 99110 (PDF)
•    Health Net of California, Inc. – HIOS 67138 (PDF)
•    Health Options, Inc. – HIOS 30252 (PDF)
•    HMO Colorado Inc(Anthem BCBS) – HIOS 76680
•    Horizon Healthcare Services, Inc. – HIOS 91661 (PDF)
•    Humana Employers Health Plan of Georgia, Inc. – HIOS 93332 (PDF)
•    Humana Health Plan of Texas, Inc. – HIOS 32673 (PDF)
•    Kaiser Foundation Health Plan of Washington – HIOS 80473 (PDF)
•    Kaiser Foundation Health Plan, Inc. – HIOS 40513 (PDF)
•    Louisiana Health Service & Indemnity Company – HIOS 97176 (PDF)
•    Medica Insurance Company – HIOS 20305 (PDF)
•    Moda Health Plan Inc – HIOS 39424 (PDF)
•    Molina Healthcare of Texas, Inc. – HIOS 45786 (PDF)
•    Oscar Insurance Company of Texas – HIOS 20069 (PDF)
•    Oxford Health Insurance, Inc. (NJ) – HIOS 77263 (PDF)
•    Oxford Health Insurance, Inc. (NY) – HIOS 85629 (PDF)
•    Premera Blue Cross (AK) – HIOS 38344 (PDF)
•    Premera Blue Cross (WA) – HIOS 49831 (PDF)
•    Providence Health Plan – HIOS 56707 (PDF)
•    Regence BlueCross BlueShield of Oregon – HIOS 77969 (PDF)
•    Rocky Mountain Hos&Med Svc(Anthem BCBS) – HIOS 33670 (PDF)
•    SelectHealth – HIOS 68781 (PDF)
•    UHC of California – HIOS 49116 (PDF)
•    UnitedHealthcare Insurance Company (WI) – HIOS 59158 (PDF)
•    UnitedHealthcare Insurance Company (CA) – HIOS 95677 (PDF)
•    UnitedHealthcare Insurance Company (TX) – HIOS 98809 (PDF)
•    UPMC Health Options – HIOS 16322 (PDF)
•    Western Health Advantage – HIOS 93689 (PDF)