In: Finance
Dynamic Medical Solutions
Case Questions
After reading the Dynamic Medical Solutions Case answer the questions below. Type your answers to the questions below in a Word document and send in through the designated drop box. Please be sure to fully answer each question. Most questions (with the exception of questions number three and five) will require at least one paragraph (three to five sentences) to answer.
Why are government regulators sensitive to the amount of claims submitted to the government insurance programs in comparison to retail prices?
Why could/would government programs reimbursement amounts exceed the retail sales prices for products?
Consider the information provided for the two products (Nutrition Supplement and Nondurable Gloves) as shown in Table 3. In accordance with the Office of the Inspector General (OIG) for “substantially in excess” are the government programs reimbursement rates for each product presently “substantially in excess” of the “usual charges?”
HINT: To determine your answer use the threshold of 120% of proposed by the OIG from page two of the case narrative and assume that DMS is charging the maximum permitted selling price to the government as shown in Table 3 on page three.
Please provide details of the details of your calculations in your submission.Use the format shown below and fill in the numbers.
Retail Price Paid by Cash & Carry Customers |
Multiplied by 120% |
Maximum Amount) Price charged to Government Customers |
||
Nutrition Supplement |
||||
Nondurable Gloves |
Based on your answer above - Assume at least one of the products violates OIG’s suggestion for “substantially in excess and consider the following scenarios.
DMS reacted by changing the price charged to cash and carry customers. Assume that the government programs reimbursement rate was no more than 20% higher than the newly calculated amount. What effect would this decision be likely to have on the future business of cash and carry customers?
DMS reacted to the dilemma by requesting reimbursement amounts below the maximum allowable reimbursement rates in order to be within 20% of the prices charged to cash and carry customers. What effect would this decision potentially have on the company’s profit margins?
OIG proposed that “good cause” for substantially in excess charges could be established in a number of ways, including, for example, “evidence of increased costs associated with serving Medicare or Medicaid beneficiaries.” Using the information from the time study conducted by DMS that is presented in Table 5 along with the department operating expenses from table 2, determine how customer service, billing, and compliance costs could be allocated by customer type.
Operating Expenses by Dept. |
and Cost |
Allocations by Customer |
|
Total Costs |
Government Programs |
Cash & Carry |
|
Customer Service |
|||
Do you think the DMS should track costs for the shipping and receiving departments and try to establish “good cause” for charging Medicare and Medicaid beneficiaries substantially more than cash and carry customers for the same products?
What thoughts do you have concerning how DMS should address the company’s weaknesses in preparation for the upcoming audit?
COMPANY INTRODUCTION AND CASE BACKGROUND
Dynamic Medical Solutions (DMS) is a small company that sells (as a
retailer of products manufactured by others) durable and nondurable
medical products to customers in seven states across the United
States. Some of the popular durable products sold by the company
are hospital beds, diabetic footwear, and mobility equipment (i.e.,
wheelchairs, scooters, etc.). A large portion of the company’s
business involves the sale of durable and nondurable medical
supplies including nutrition supplements, gloves, and personal care
products used in patient care. All of the products carried by DMS
are over-the-counter items and thus do not require a physician’s
prescription.1 Like most companies in the medical products supply
industry, DMS serves a multitude of customers, including those with
(1) no insurance (i.e., cash and carry), (2) Medicare and Medicaid
benefits (i.e., government programs),2 and (3) private insurance.
Accordingly, DMS has a billing department internally for customers
with such benefits and insurance. Many customers, including those
enrolled in government programs and those who pay for products out
of pocket (i.e., cash and carry) are elderly and/or reside in
assisted-living facilities. The company employs sales
representatives who visit these facilities and interact with the
customers and their caregivers on a regular basis and establish the
ordering process for the customers via phone or fax. Customers also
are able to purchase goods at one of the company’s five retail
stores via the company’s website or through the phone/fax process
with a sales representative.
In regard to cash and carry customers, DMS strives to offer
competitive prices as the company is directly competing with large
national retail stores that offer many types of medical products
and operate on small profit margins. Serving cash and carry
customers is fairly straightforward, involving no other
considerations beyond the typical sales initiation (i.e., visits
from a sales representative), point-of-sale sales, and warehouse
shipping or customer pick-up processes.
On the other hand, serving government programs customers is more
restrictive and requires an extensive number of internal processes
and procedures. The prices charged to these customers (i.e., the
reimbursement amount) are set by the program entity (i.e., Medicaid
or Medicare). Most importantly, the process of selling goods
involves additional mandated (by law) considerations beyond the
normal cash-and-carry process, including the written verification
of medical necessity from the customer’s physician, the processing
of insurance claims, and the substantiation of product delivery.
For many of the nondurable medical supplies, such as nutrition
supplements and gloves, the process is even more cumbersome as
these products are supplied to customers on a monthly basis.
Accordingly, proof of medical necessity for these products also has
to be updated on a recurring basis. This involves
IMA EDUCATIONAL CASE JOURNAL VOL. 7, NO. 2, ART. 3, JUNE 2014
1
ISSN 1940-204X
Dynamic Medical Solutions:
Expanding the Application of Cost Management Principles to Channel
and Customer Profitability Analysis
Casey J. McNellis, Ph.D., CPA
University of Montana
Ronald F. Premuroso, Ph.D., CPA, CFE
University of Montana
additional interaction by the company with primary care physicians
and Medicare/Medicaid representatives, as well as increased
processing of paperwork.
Sales to customers using private insurance comprise an immaterial
amount of the company’s revenues. Most private insurance companies
cover only a minor amount of the charges for the products offered
by DMS, often after a government program has been billed first and
has paid for the majority of the charge billed by DMS.
Table 1 provides a breakdown of DMS’s sales for the most recent
financial year, along with other relevant financial information
(excluding an immaterial amount for private insurance-related
sales).
Table 1: DMS Sales by Customer Type and Other Financial
Information
Sales
% of Total Sales
Government Programs Sales
$3,000,000
75.0%
Cash and Carry Sales
$1,000,000
25.0%
Total Net Sales
$4,000,000
100.0%
Cost of Sales
($1,300,000)
32.5%
Gross Profit
$2,700,000
67.5%
Operating Expenses
($2,200,000)
55.0%
Operating Income
$ 500,000
12.5%
The company’s operations are divided into five departments:
Customer Service, Shipping, Billing, Compliance, and
Administration. Table 2 includes a breakdown of the operating
expenses by department along with a brief description of the
general functions carried out by each department for the most
recent financial year.
Table 2: Department Operating Expenses and Descriptions
Department
Operating Expenses
Description of Functions
Customer Service
$660,000
Process sales orders; support customer base
Shipping
$870,000
Prepare orders for shipment; track shipments to delivery
Billing
$120,000
Submit insurance claims; monitor customer eligibility for
government programs
Compliance
$120,000
Monitor company policies regarding government programs
Administration
$430,000
Perform bookkeeping, payroll, and marketing functions; heat, light,
and power; insurance expenses; execute strategic plan
Total Operating Expenses
$2,200,000
REGULATORY ENVIRONMENT
As Table 1 depicts, DMS’s primary source of sales are from
customers who are eligible for assistance from government-related
healthcare programs. As such, the company’s success is largely
based on understanding government regulations, policies, and
procedures governing Medicare and Medicaid programs, including
reimbursements.
Because of past alleged abuses of these government insurance
programs by healthcare providers, Federal and state authorities
have enacted several regulations under the Social Security Act for
providers like DMS involved with submitting reimbursement claims
under government programs. For example, the Department of Health
and Human Services (HHS) has the power to revoke a company’s
privileges to serve Medicare and Medicaid customers if the company
has been involved in criminal activity, patient abuse, and/or
healthcare fraud. Additionally, the Act also allows HHS to prohibit
a company from engaging in business activities with Medicare and/or
Medicaid if the company submits product reimbursement claims for
government programs customers significantly higher than amounts
charged to cash and carry customers. Specifically, Section 1128(b)
of the Act states that HHS:
“…may exclude…from participation in any Federal health care
program…any individual or entity that the Secretary determines…has
submitted or caused to be submitted bills or requests for payment
(where such bills or requests are based on charges or cost) under
Title XVIII or a State health care program containing charges (or,
in applicable cases, requests for payment of costs) for items or
services furnished substantially in excess of such individual’s or
entity’s usual charges (or, in applicable cases, substantially in
excess of such individual’s or entity’s costs) for such items or
services, unless the Secretary finds there is good cause for such
bills or requests containing such charges or costs.” (Emphasis
added.)
The language of this regulation was further interpreted in a
proposal by the Office of the Inspector General (OIG) in June
2007.3 The phrase “usual charges” was suggested to include “charges
billed directly to cash paying patients” (i.e., cash and carry
customers). The term “substantially in excess” was defined by the
OIG proposal as charges exceeding “120 percent of an individual’s
or entity’s usual charges.” Finally, the OIG proposed that “good
cause” for “substantially in excess” charges could be established
in a number of ways, including, for example, evidence of “increased
costs associated with serving Medicare or Medicaid
beneficiaries.”
IMA EDUCATIONAL CASE JOURNAL VOL. 7, NO. 2, ART. 3, JUNE 2014
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DMS’S DILEMMA
DMS sends a member of the management team to a government programs
seminar, where firms are provided information and guidelines
regarding Federal regulations governing Medicare and Medicaid
reimbursements. The team member is amazed by the number of
regulations governing these programs, including the one mentioned
earlier. Because the team member is not familiar with the methods
that ensure DMS is in compliance with these regulations, he holds a
meeting with the rest of the management team to discuss the
regulations. The management team agrees it is necessary to hire a
healthcare consultant to review DMS’s policies, procedures, and
billing practices for products sold to customers under government
programs.
After examining DMS’s operations in some detail, the healthcare
consultant hired by DMS informed management of a grim, unexpected
finding: DMS’s product pricing appeared to be in violation of
Federal regulations governing Medicare and Medicaid reimbursements.
The aforementioned regulation was the issue referenced by the
healthcare consultant in determining DMS was potentially in
violation of the Federal Act. The consultant examined all of the
company’s products and determined many of them had Medicaid
reimbursement rates “substantially in excess” of prices charged to
cash and carry customers. According to the consultant, DMS would
likely have to change its pricing structure and/or potentially
eliminate the sale of certain products sold by the company to
remedy the violation. Accordingly, the company was advised to
employ one of the following courses of action: either raise cash
and carry prices for products not complying with the 120% proposed
“rule,” or eliminate sales of the two selected products to cash and
carry customers. Discouraged by the findings and faced with
uncertainty and potentially disastrous consequences, the DMS
management team members contemplated their next moves.
DMS’S INITIAL CONCERNS AND RESPONSE
Given the substantial portion of DMS’s sales from customers
eligible for government program reimbursements, the issue of
product pricing is therefore critical to the company. Prices
offered to cash and carry customers must be competitive, yet they
must be within a certain percentage of government program
reimbursement claims in order for DMS to comply with government
regulations. As such, pricing decisions have the potential to not
only adversely impact DMS’s market share of cash and carry
customers but also may put the company’s ability to sell and
receive reimbursement for these products under the respective
government programs in jeopardy.
Unhappy with these two alternatives suggested by the consultant,
company officials began compiling product pricing and costing data,
as well as observing and documenting key operational aspects of the
business to determine the extent of the problem revealed by the
consultant and to develop potential alternative courses of
action.
SELECTED PRODUCT PRICING DATA
The first two products examined by management were the nutrition
supplement and nondurable gloves, two products eligible for
reimbursement under government insurance programs. Table 3 includes
selected information for these two products in the latest financial
year.
IMA EDUCATIONAL CASE JOURNAL VOL. 7, NO. 2, ART. 3, JUNE 2014
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Table 3: Information for Selected Products Offered by DMS
Nutrition Supplement (1 can)
Nondurable Gloves (1 box)
Retail sales price (paid by cash and carry customers)
$1.54
$6.95
Maximum permitted selling price to government*
$2.20
$8.82
Product cost
$0.66
$2.65
Product sales as a % of cash and carry sales
3%
4%
Quantity of product sold to cash and carry customers
19,480 cans
5,755 boxes
Product sales as a % of government programs sales
6%
6%
Quantity of product sold to government programs customers
81,800 cans
20,408 boxes
*This maximum permitted selling price to the government applies to
all companies in general under specific regulations pertaining to
these products issued by the government.
BUSINESS OBSERVATIONS
Management was inclined to believe disproportionate shares of
company resources were being devoted to serving government program
customers, especially in the case of nutrition and nondurable
products (i.e., gloves), which involved additional processing costs
in order to comply with regulations. But they had no formal
evidence to support this belief and thus needed to obtain relevant
information about the efforts being exerted to serve the two
different customer types: cash and carry and government programs.
As a first step, the officials observed employees from each
department to obtain an understanding of the sales and order
fulfillment processes, separately, for the cash and carry and
government program customers. Information about these processes
from new sales origination all of the way through billing are
detailed in Table 4.
As part of these observations, company employees from selected
departments were asked to keep track of the amount of time they
spent on the different types of customer orders and related
activities for a one-month period. Because of increased work
demands at the time the study was performed, similar time data was
not immediately obtained from employees working in the Shipping or
Administration departments. The results are presented in Table
5.4
IMA EDUCATIONAL CASE JOURNAL VOL. 7, NO. 2, ART. 3, JUNE 2014
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Table 4: Summary of Relevant Portions of Company Processes
New sales origination
Cash and carry: A company salesperson visits nursing homes,
hospitals, and assisted-living facilities, speaking with potential
customers and guardians. The salesperson takes orders and
phones/faxes them to warehouse customer service
representatives.
Government programs: Same as cash and carry.
Recurring sales
Cash and carry: A customer service representative contacts
customers and takes sales orders.
Government programs: Same as cash and carry.
Order fulfillment
Cash and carry: A representative from customer service enters the
order into the company’s accounting system. The system produces a
pick slip, which is forwarded to Shipping. The employees in
Shipping fill the order, which is then given to a third-party
courier for delivery. A copy of the pick slip is sent back to the
customer service representative.
Government programs: Per regulations, DMS must obtain a valid
identification card proving the customer’s eligibility for the
government program. To establish medical necessity, a doctor’s
order is required to be submitted with each order. A customer
service representative prepares fax inquiries to the customer’s
physician (to establish medical necessity) and to the customer for
valid proof of eligibility (if a copy was not obtained by the
salesperson). Upon receipt of this documentation, the order is
entered into the accounting system. The system produces a pick
slip, which is forwarded to Shipping. The employees in Shipping
fill the order, which is then given to a third-party courier for
delivery. A copy of the pick slip is sent to a Billing
representative. Shipping employees track shipments with the
courier’s website to confirm delivery.
Billing
Cash and carry: A representative from customer service examines the
pick slips sent back from Shipping and prepares an invoice to the
customer. The customer has 30 days to pay the invoice.
Government programs: A representative from Billing prepares a
government program claim and submits it. The reimbursement usually
takes between 15-60 days.
Other
Government programs: Renewals for nutrition and nondurable goods:
Periodically, a customer’s physician order and proof of eligibility
documentation are required to be renewed. A billing representative
tracks these customers and prepares renewal requests when
appropriate.
Government programs: Oversight: Per regulations, DMS is required to
have a compliance program staffed with a compliance officer, whose
sole responsibility is to oversee compliance issues and related
employee training.
Retail store and website transactions
Customers also visit the company’s retail stores and website on
their own. For cash and carry customers, the retail store process
in similar to point-of-sale transactions of major retail stores.
For website sales, a sales representative is not involved. Rather,
the customer places the order, which is then sent to a customer
service representative. At that point, the customer service
representative processes the order in the same way as described
under “Order fulfillment.” Transactions with government programs
customers visiting the retail stores are still processed in
accordance with the steps above. But no sales representative is
involved in the transaction. In general, government programs
customers do not place orders via the company website.
CASE QUESTIONS
1. Why are government regulators sensitive to the amount of claims
submitted to the government insurance programs in comparison to
retail prices?
2. Why potentially could/would government programs reimbursement
amounts exceed the retail sales prices
for products?
3. Consider the information provided for the two products shown in
Table 3. In accordance with the OIG’s suggestions for
“substantially in excess,” are the government programs
reimbursement rates for each product presently “substantially
in excess” of the “usual charges”? Provide the details of your
calculations in your submission.
4. Assuming at least one of the products violates the OIG’s
suggestion for “substantially in excess,” discuss the impact of the
following three potential solutions to this dilemma on DMS’s market
share, operations, exposure to liability, and so on. In your
assessment, consider the future financial implications of the three
alternatives along with the assumptions you have made in your
analysis.
a. Raise prices charged to cash and carry customers such that the
government programs reimbursement rate is no more than 20% higher
than the newly calculated amount.
b. When submitting government program claims, request reimbursement
amounts below the maximum allowable reimbursement rates in order to
be within 20% of the prices charged to cash and carry
customers.
c. Attempt to establish “good cause.” Refer to some of the
principles and concepts you have learned or are learning in your
cost management course (for example, Customer Profitability
Analysis and allocations of overhead) in establishing “good cause.”
Provide details of your calculations, which will aid DMS in
establishing “good cause” and apply them to the two specific
products shown in Table 3. (Hint: This will require you to perform
cost allocations and select appropriate bases for the
allocation(s).) What are your revised total cost per unit and
overall profit margin amounts on the two products?
5. Looking back at your calculations and analyses performed in
question 4c, do you believe the company can establish and support
“good cause’ in submitting claims for the maximum allowable rates
offered by government programs? In answering the question, first
consider the qualitative evidence you have already developed.
Second, develop a quantitative analysis appropriate to use in
establishing or supporting your qualitative evidence.
6. In anticipation of the regulating agencies performing an
investigation into the pricing structure of DMS, identify the
strengths and weaknesses of the work performed by DMS in response
to the consultant’s findings as well as the analysis you provided
in the previous questions. How should DMS address the weaknesses in
preparation for the audit?
ENDNOTES
1 On the other hand, customers with private insurance or access to
government medical programs are required to provide evidence of
medical necessity, which is often indicated by physician orders,
for reimbursement.
2 Medicare is a national social insurance program administered by
the U.S. Federal Government since 1966, which guarantees access to
health insurance coverage for U.S. citizens age 65 or older who
have worked and paid into the program. Medicaid is a U.S.
government insurance program for all U.S. citizens whose income or
personal resources are unable to pay for their personal
healthcare.
3 Department of Health and Human Services (HHS) and the Office of
the Inspector General (OIG), “Medicare and State Health Care
Programs: Fraud and Abuse; Clarification of Terms and Application
of Program Exclusion Authority for Submitting Claims Containing
Excessive Charges,” Federal Register Volume 72, No. 116, June 18,
2007.
4 The firm does not have any type of bank borrowings or debt, and
thus there is no interest expense in overhead-related expenses to
consider.
Why are government regulators sensitive to the amount of claims submitted to the government insurance programs in comparison to retail prices?
Solution:
Reimbursement for goods provided to government programs customers are funded by taxpayer dollars directed to the appropriate government agencies. As such, companies like DMS engage in order fulfilment with the customer, but submit billing requests to government agencies for reimbursement. This arrangement provides companies with the potential opportunity to abuse the system by submitting fictitious claims excessive claims, and so on. Government programs reimbursement claims that are excessive in comparison to cash and carry prices may be indicative of the potential for such abuses and misappropriation of government funds.
Why could/would government programs reimbursement amounts exceed the retail sale prices for products?
Solution:
There could be several reasons:
Primary Reason: Additional mandates for serving customers of government programs.
Considerations include
(1) verification of medical necessity
(2) verification of eligibility
(3) Proof of delivery
These activities require more resources than those required for the typical point-of-sale process that are in place for cash and carry customers. Government agencies are compensating providers not only for the retail value of the goods provided but also for the resources consumed by these types of government mandates.
Second reason: Government reimbursement rates may not have been updated to incorporate changes in marketing pricing for the goods.
Consider the information provided for the two products (Nutrition Supplement and Nondurable Gloves) as shown in Table 3. In accordance with the Office of the Inspector General (OIG) for “substantially in excess” are the government programs reimbursement rates for each product presently “substantially in excess” of the “usual charges?”
HINT: To determine your answer use the threshold of 120% of proposed by the OIG from page two of the case narrative and assume that DMS is charging the maximum permitted selling price to the government as shown in Table 3 on page three.
Please provide details of the details of your calculations in your submission. Use the format shown below and fill in the numbers.
Item |
Retail Price Paid by Cash & Carry Customers |
Multiplied by 120% |
Maximum Amount) Price charged to Government Customers |
Difference |
Nutrition Supplement |
$1.54 |
|||
Nondurable Gloves |
6.95 |
Solution:
Item |
Retail Price Paid by Cash & Carry Customers |
Multiplied by 120% |
Maximum Amount) Price charged to Government Customers |
Difference |
Nutrition Supplement |
$1.54 |
1.54 * 1.2 = 1.848 |
$2.8 |
2.8 / 1.54 = 1.43% |
Nondurable Gloves |
6.95 |
6.95 * 1.2 = 8.34 |
$8.82 |
8.82 / 6.95 = 127% |
Based on your answer above - Assume at least one of the products violates OIG’s suggestion for “substantially in excess and consider the following scenarios.
DMS reacted by changing the price charged to cash and carry customers. Assume that the government programs reimbursement rate was no more than 20% higher than the newly calculated amount. What effect would this decision be likely to have on the future business of cash and carry customers?
Solution:
Nutritional Supplement |
Nondurable Gloves |
||
Maximum permitted selling price to government (given) |
$2.20 |
$8.82 |
|
OIG Threshold % (for determining “substantially in excess”) |
120% |
120% |
120% |
Newly calculated “Cash & Carry” Price (based on government program pricing) |
2.20 / 120% = $1.83 |
8.82 / 120% = $7.35 |
|
Original Pricing (given) |
$1.54 |
$6.95 |
|
% increase to original “Cash & Carry” pricing |
(1.83 – 1.54 ) / 1.54 = 19% |
(7.35 – 6.95) / 6.95 = 6% |
Note: Although this price increase to cash and carry customers would push up pricing for government programs customers to the maximum reimbursable amounts, market competition from the national retail superstores would drive the cash and carry customers to purchase from those stores at lower prices.
DMS reacted to the dilemma by requesting reimbursement amounts below the maximum allowable reimbursement rates in order to be within 20% of the prices charged to cash and carry customers. What effect would this decision potentially have on the company’s profit margins?
Solution:
Nutritional Supplement |
Nondurable Gloves |
||
“Usual” charges (paid by cash & carry” customers |
$1.54 |
$6.95 |
|
OIG Threshold % (for determining “substantially in excess”) |
120% |
120% |
120% |
Maximum Reimbursement (from government, based on current pricing) |
1.54 * 120% = $1.85 |
6.95 * 120% = $8.34 |
Note: This course of action could be problematic for several reasons:
OIG proposed that “good cause” for substantially in excess charges could be established in a number of ways, including, for example, “evidence of increased costs associated with serving Medicare or Medicaid beneficiaries.” Using the information from the time study conducted by DMS that is presented in Table 5 along with the department operating expenses from table 2, determine how customer service, billing, and compliance costs could be allocated by customer type.
Operating Expenses by Dept. |
and Cost |
Allocations by Customer |
|
Total Costs |
Government Programs |
Cash & Carry |
|
Customer Service |
$660,000 |
||
Billing |
$120,000 |
||
Compliance |
$120,000 |
Solution:
Allocation |
Allocated Amounts |
Total |
||
Customer Service |
Time (85 / 15) |
($561,000) |
($99,000) |
($660,000) |
Shipping |
Sales (75 / 25) |
($652,500) |
($127,500) |
($870,000) |
Billing |
Time (100 / 0) |
($120,000) |
0 |
($120,000) |
Compliance |
Time (100 / 0) |
($120,000) |
0 |
($120,000) |
Administration |
Sales (75 /25) |
($322,500) |
($107,500) |
($430,000) |
Total Operating Expenses |
($1,776,000) |
($424,000) |
($2,200,000) |
|
Operating Income |
$249,000 |
$251,000 |
$500,000 |
Government |
Cash & Carry |
|||
Nutrition |
Gloves |
Nutrition |
Gloves |
|
% Sales |
6% |
6% |
3% |
4% |
Overhead |
$106,560 |
$106,560 |
$12,720 |
$16,960 |
Units Sold |
81,800 |
20,408 |
19,480 |
5,755 |
Overhead Cost (per unit) |
$1.30 |
$5.22 |
$0.65 |
$2.95 |
Product Cost (per unit) |
$0.66 |
$2.65 |
$0.66 |
$2.65 |
Total Cost (per unit) |
$1.96 ($1.30 + 0$0.66) |
$7.87 ($5.22 + $2.65) |
$1.31 ($0.65 + $0.66) |
$5.60 ($2.95 + $2.65) |
Price per unit – Cash & Carry |
$1.54 |
$6.95 |
||
Price per unit – (Government) |
$2.20 |
$8.82 |
||
Profit% |
10.79% |
10.75% |
14.74% |
19.47% |
Do you think the DMS should track costs for the shipping and receiving departments and try to establish “good cause” for charging Medicare and Medicaid beneficiaries substantially more than cash and carry customers for the same products?
What thoughts do you have concerning how DMS should address the company’s weaknesses in preparation for the upcoming audit?
Solution:
Even though government program reimbursements are larger than amounts paid by cash and carry customers, the profit % on government program customers are lower. This would provide some initial evidence to support “good cause” for the company’s current pricing of both nondurable gloves and the nutrition supplement to government program customers.
The detailed fulfilment process requirements outlined in Table 4 of the case provides additional evidence that more time and effort are expended on government program customers compared to cash and carry customers. Not only does the government reimbursement process entail more tasks, it also requires entire departments devoted to handling the business of processing government program orders.
What thoughts do you have concerning how DMS should address the company's weaknesses in preparation for the upcoming audit?
Solution:
Weaknesses of Analysis:
The regulators could insist that a traditional costing approach (i.e., based purely on sales volume of products) would be more appropriate since these products (1) are a relatively small portion of overall sales, (2) have similar sales volumes by percentage.
The regulators could argue the appropriateness of your use of cost allocation based on both stages of the process. First stage allocations were based on either time spent by the departments or the % of sales. Then, second stage allocations (to individual products) were again based on % of sales. Where other allocation bases (e.g., % of orders processed) considered and how would profitability change be using other allocation bases? Why was it appropriate to utilize the % of sales as an allocation base for both shipping and Administration departments (vs. time spent, which was used for the other departments)?
Since Shipping and Administration make up such a large portion (60%) of the total operating costs, DMS should consider tracking several different allocation bases to see how allocations of operating costs might be affected.
DMS should consider trading many different allocation bases to ensure that their conclusions with respect to costs and pricing are as robust as possible.