text: b" Report Template Update = 04-30-05_rev.15\n\n\n\n\nDepartment of Health and Human Services\n\n OFFICE OF \n\n INSPECTOR GENERAL \n\n\n\n\n\n SUSPECTED MEDICAID FRAUD \n\n REFERRALS\n\n\n\n\n\n Daniel R. Levinson\n\n Inspector General \n\n\n January 2007\n\n OEI-07-04-00181\n\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\n Office of Inspector General \n\n http://oig.hhs.gov\n\nThe mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452,\nas amended, is to protect the integrity of the Department of Health and Human Services\n(HHS) programs, as well as the health and welfare of beneficiaries served by those\nprograms. This statutory mission is carried out through a nationwide network of audits,\ninvestigations, and inspections conducted by the following operating components:\n\nOffice of Audit Services\nThe Office of Audit Services (OAS) provides all auditing services for HHS, either by\nconducting audits with its own audit resources or by overseeing audit work done by others.\nAudits examine the performance of HHS programs and/or its grantees and contractors\nin carrying out their respective responsibilities and are intended to provide independent\nassessments of HHS programs and operations. These assessments help reduce waste,\nabuse, and mismanagement and promote economy and efficiency throughout HHS.\n\nOffice of Evaluation and Inspections\nThe Office of Evaluation and Inspections (OEI) conducts national evaluations to provide\nHHS, Congress, and the public with timely, useful, and reliable information on\nsignificant issues. Specifically, these evaluations focus on preventing fraud, waste, or\nabuse and promoting economy, efficiency, and effectiveness in departmental programs.\nTo promote impact, the reports also present practical recommendations for improving\nprogram operations.\n\nOffice of Investigations\nThe Office of Investigations (OI) conducts criminal, civil, and administrative\ninvestigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries\nand of unjust enrichment by providers. The investigative efforts of OI lead to criminal\nconvictions, administrative sanctions, or civil monetary penalties.\n\nOffice of Counsel to the Inspector General\nThe Office of Counsel to the Inspector General (OCIG) provides general legal services to\nOIG, rendering advice and opinions on HHS programs and operations and providing all\nlegal support in OIG's internal operations. OCIG imposes program exclusions and civil\nmonetary penalties on health care providers and litigates those actions within HHS.\nOCIG also represents OIG in the global settlement of cases arising under the Civil False\nClaims Act, develops and monitors corporate integrity agreements, develops compliance\nprogram guidances, renders advisory opinions on OIG sanctions to the health care\ncommunity, and issues fraud alerts and other industry guidance.\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nF I N D I N G S\n\xce\x94 E X E C U T I V E S U M M A R Y \n\n\n\n OBJECTIVES\n To determine (1) the sources and number of suspected fraud referrals\n that Medicaid Fraud Control Units (MFCU) reported receiving and\n (2) the number of these referrals that they accepted for investigation.\n\n\n BACKGROUND\n Recent events, such as the passage of the Deficit Reduction Act of 2005,\n have focused attention on Medicaid program integrity. Within most\n States, two agencies share primary responsibility for protecting the\n integrity of the Medicaid program. The State Medicaid agency is\n responsible for ensuring proper payment, recovering misspent funds,\n identifying suspected Medicaid fraud, conducting a preliminary review\n to determine the extent of potential fraud, and making referrals to its\n MFCU. The MFCU is responsible for reviewing the referrals it receives\n from the State Medicaid agency and other sources to determine if the\n issues involved merit criminal and/or civil investigation.\n\n The Office of Inspector General (OIG) requested that MFCUs provide\n data on the number of suspected fraud referrals received and the\n number accepted for investigation from the State Medicaid agencies and\n from other sources for the period July 2002 through June 2005.\n\n\n FINDINGS\n Medicaid Fraud Control Units reported receiving a total of\n 13,733 suspected fraud referrals over a 3-year period, of which\n 29 percent came from State Medicaid agencies. Eighty-four percent of\n MFCUs providing information reported receiving less than half of all\n suspected fraud referrals from their respective State Medicaid agencies.\n Referrals from State Medicaid agencies ranged from 0 to 215 for any\n 1-year period and from 7 to 590 for the 3-year study period (July 2002\n through June 2005).\n\n Overall, State Medicaid agency contributions to total MFCU-accepted\n referrals remained constant over a 3-year period, but individual States\n fluctuated widely. The percentage contribution of MFCU-accepted\n referrals from State Medicaid agencies remained constant during the\n 3-year study period at 33 percent, yet the contributions from individual\n State Medicaid agencies to their respective MFCUs fluctuated greatly.\n Fifty-nine percent (26/44) of MFCUs reported accepting fewer referrals\n from their respective State Medicaid agency in the last year of our\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n i\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nE X E C U T I V E S U M M A R Y\n\n\n review compared to the average number of referrals over all 3 years.\n This indicates that increases in accepted referrals are concentrated in\n less than half of the States. One State Medicaid agency contributed to\n 67 percent of the increase in MFCU-accepted referrals over the 3-year\n study period.\n\n\n RECOMMENDATION\n We recommended in our November 1996 report \xe2\x80\x9cSurveillance and\n Utilization Review Subsystems\xe2\x80\x99 Case Referrals to Medicaid Fraud\n Control Units,\xe2\x80\x9d OEI-07-95-00030, that the Centers for\n Medicare & Medicaid Services (CMS) establish fraud referral\n performance standards for State Medicaid agencies. While CMS\n concurred with this recommendation, it has not established these\n performance standards.\n\n In the absence of CMS criteria specific to the referral of suspected fraud\n issues, we are unable to determine the adequacy of State Medicaid\n agencies\xe2\x80\x99 performance. Such criteria would assist State Medicaid\n agencies by providing specifics concerning the development and referral\n of suspected fraud issues to MFCUs. In addition, such criteria would\n help ensure that the content and manner of referring suspected fraud\n issues is consistent across States. However, some reported results, such\n as no fraud referrals for an entire year or only one accepted referral over\n 3 years, do not appear adequate given the State Medicaid agencies\xe2\x80\x99\n access to Medicaid claims information and their designated role to\n identify and refer suspected fraud issues to MFCUs.\n\n Given the findings in our report and our inability to assess the adequacy\n of State Medicaid agency performance, due to the absence of referral\n criteria, we reiterate this recommendation.\n\n\n AGENCY COMMENTS\n CMS concurred with our recommendation to work towards the\n establishment of fraud referral performance standards. CMS indicated\n that it is in the process of engaging a strategic contractor to conduct a\n comprehensive State program integrity assessment. CMS intends to\n consult with OIG regarding arriving at a commonly accepted definition\n of what constitutes an accepted referral.\n\n\n\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n ii\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nE X E C U T I V E S U M M A R Y \n\n\n\n\n\n OFFICE OF INSPECTOR GENERAL RESPONSE\n CMS comments to the report were based on numbers contained in the\n draft report. However, one State advised OIG after reviewing the draft\n report that it had provided OIG incorrect information in response to the\n initial data request, and it was unable to provide information that\n completely responded to our request. The State was eliminated from\n our analyses. Although we still find that the number of referrals does\n increase in each year of our study, the increase is less dramatic than\n indicated in the draft report and the percentage of referrals coming from\n State agencies drops in the last year when compared to the prior year.\n\n\n\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n iii\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\n\xce\x94 T A B L E O F C O N T E N T S \n\n\n\n\n EXECUTIVE SUMMARY .....................................i\n\n\n\n\n INTRODUCTION ........................................... 1\n\n\n\n\n FINDINGS ................................................. 6\n\n MFCUs reported receiving 13,733 suspected fraud referrals over \n\n a 3-year period, of which 29 percent are from State Medicaid \n\n agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 \n\n\n Overall, State Medicaid agency contributions to total \n\n MFCU-accepted referrals remained constant over a 3-year period, \n\n but individual States fluctuated widely . . . . . . . . . . . . . . . . . . . . . . 7 \n\n\n\n\n RECOMMENDATION ....................................... 9\n\n\n\n\n A P P E N D I X E S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 \n\n A: \tMFCU\xe2\x80\x93Reported Referral Data From State \n\n Medicaid Agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 \n\n\n B: \tMFCU\xe2\x80\x93Reported Referral Data From Other Sources . . . . . . . 13 \n\n\n C: \tComparison of Accepted Referral and Contribution Rates . . . 14 \n\n\n D: Agency Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 \n\n\n A C K N O W L E D G M E N T S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 \n\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nI N T R O D U C T I O N\n\xce\x94 I N T R O D U C T I O N \n\n\n\n OBJECTIVES\n To determine (1) the sources and number of suspected fraud referrals\n that Medicaid Fraud Control Units (MFCU) reported receiving and\n (2) the number of these referrals that they accepted for investigation.\n\n\n BACKGROUND\n The Deficit Reduction Act of 2005 created a new Medicaid Integrity\n Program (MIP) and provided additional funding for the Secretary of the\n Department of Health and Human Services (HHS) to conduct Medicaid\n program integrity activities.1 The MIP funding will assist the Centers\n for Medicare & Medicaid Services (CMS) in these activities. As part of\n this funding, CMS will hire approximately 100 auditors to conduct\n Federal reviews of State Medicaid agency programs. In addition,\n funding received pursuant to the Deficit Reduction Act of 2005 will\n assist the Office of Inspector General (OIG) in its oversight of Medicaid\n integrity efforts.\n\n Within most States, two agencies share primary responsibility for\n protecting the integrity of the Medicaid program. The State Medicaid\n agency is responsible for ensuring proper payment, recovering misspent\n funds, identifying suspected Medicaid fraud, conducting a preliminary\n review to determine the extent of potential fraud, and making referrals\n to its MFCU. The MFCU is responsible for reviewing the referrals it\n receives from the State Medicaid agency and other sources to determine\n if the issues involved merit criminal and/or civil investigation. The\n MFCU would then either accept the referral for investigation or decline\n the referral. In situations where the referral is declined, the referring\n agency can initiate appropriate administrative actions.\n State Medicaid Agency Responsibilities\n The State Medicaid agency must conduct preliminary investigations\n when questionable practices or complaints of suspected Medicaid fraud\n are identified or received.2\n\n\n\n\n 1 Public Law 109-171. \n\n\n 2 42 CFR \xc2\xa7 455.14. \n\n\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 1\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nI N T R O D U C T I O N\n\n\n When a preliminary investigation gives the State Medicaid agency\n reason to believe that an incident of fraud has occurred, it must refer\n the matter to the MFCU for investigation.3\n State Medicaid agencies must have certain information processing\n systems, including a Medicaid Management Information System\n (MMIS), to accomplish the tasks for which they are responsible.4 A vital\n part of the MMIS is the Surveillance and Utilization Review Subsystem\n (S/URS). Two of the primary functions of the S/URS are: (1) to develop\n a comprehensive statistical profile of health care delivery and\n utilization patterns by providers and recipients, and (2) to investigate\n and reveal misutilization of the State\xe2\x80\x99s Medicaid program by\n participants and promote correction.5 Some State Medicaid agencies\n exclusively use staff within the S/URS unit to conduct analyses, while\n others have established comprehensive program integrity or Inspector\n General units to oversee these functions.\n Medicaid Fraud Control Unit Responsibilities\n MFCUs are responsible for conducting statewide programs for\n investigating and prosecuting violations of all applicable State laws\n regarding any and all aspects of fraud in connection with any aspect of\n the provision of medical assistance and the activities of providers of\n such assistance under the State Medicaid plan.6 Forty-eight States and\n the District of Columbia (hereinafter referred to collectively as States)\n have established MFCUs.7\n MFCUs are responsible for conducting criminal and/or civil\n investigations of suspected Medicaid fraud and are considered\n integrated law enforcement components. MFCUs must be single\n identifiable entities of the State government, composed of investigators,\n attorneys, and auditors.8 Most MFCUs are located within the State\n\n\n\n 3 42 CFR \xc2\xa7 455.15(a)(1) and 42 CFR \xc2\xa7 433.116(h). In States without a MFCU, the State\n Medicaid agency must conduct a full investigation or refer the fraud issue to the\n appropriate law enforcement agency.\n 4 42 U.S.C. \xc2\xa7\xc2\xa7 1903(a)(3) and 1903(r), 42 CFR \xc2\xa7 433.110 and Part 11 of the State Medicaid\n Manual.\n 5 Section 11335 of the State Medicaid Manual.\n 6 42 U.S.C. \xc2\xa7 1396b(q)(3) and 42 CFR \xc2\xa7 1007.11.\n\n 7 The HHS Inspector General granted North Dakota and Idaho waivers of MFCU\n\n requirements; thus the State Medicaid agency in each of these States is responsible for\n conducting investigations and referring cases to State and local prosecutors.\n 8 42 U.S.C. \xc2\xa7 1396b(q)(6).\n\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 2\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nI N T R O D U C T I O N\n\n\n Attorney General\xe2\x80\x99s office. OIG has been delegated responsibility for\n MFCU oversight and certifying and recertifying that each MFCU meets\n selected Federal requirements.9\n Section 1902(a)(61) of the Social Security Act, as amended by\n section 13625 of the Omnibus Budget Reconciliation Act of 1993,\n required OIG to develop performance standards for assessing MFCUs.\n These standards became effective on September 26, 1994. One of these\n performance standards requires MFCUs to ensure they maintain an\n adequate workload of referrals from State Medicaid agencies and other\n sources (e.g., licensure authorities, insurance departments, providers,\n and private citizens).\n Previous Studies\n Since 1989, OIG has issued three reports addressing the referral of\n suspected fraud issues from State Medicaid agencies to MFCUs.10\n These reports identified variations among the State Medicaid agencies\n in their relationships with and methods of referral to MFCUs.\n Additionally, each of these studies identified deficiencies in the referral\n process, such as a lack of communication between State Medicaid\n agencies and MFCUs and a lack of understanding of roles and\n responsibilities.\n\n The Government Accountability Office (GAO) has also conducted a\n number of studies that identified vulnerabilities in the Medicaid\n program and in State Medicaid agencies\xe2\x80\x99 efforts to detect and refer\n suspected fraud issues to MFCUs. In a 2004 report, GAO noted that\n CMS\xe2\x80\x99s efforts to ensure State Medicaid agency compliance might be\n \xe2\x80\x9c. . . disproportionately small relative to the risk of serious financial\n loss.\xe2\x80\x9d11\n\n\n METHODOLOGY\n We requested suspected fraud referral data from both State Medicaid\n agencies and MFCUs in the 48 States that had MFCUs during the\n\n\n 9 42 U.S.C. \xc2\xa7 1396b(q)(7).\n\n 10 \xe2\x80\x9cReferrals by Medicaid agencies to Fraud Control Units,\xe2\x80\x9d OAI-03-88-00170,\n\n October 1989; \xe2\x80\x9cSurveillance and Utilization Review Subsystems\xe2\x80\x99 Case Referrals to\n Medicaid Fraud Control Units,\xe2\x80\x9d OEI-07-95-00030, November 1996; \xe2\x80\x9cMedicaid Post\n Payment Safeguards,\xe2\x80\x9d OEI-05-99-00072, July 2000.\n 11 \xe2\x80\x9cState and Federal Efforts to Prevent and Detect Improper Payments,\xe2\x80\x9d Government\n\n Accountability Office Report to the Chairman, Committee on Finance, U.S. Senate,\n GAO 04-707, July 2004.\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 3\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nI N T R O D U C T I O N\n\n\n 3-year period July 2002 through June 2005. Idaho and North Dakota\n have not established MFCUs due to waivers and Nebraska established\n its MFCU toward the end of our study period. Therefore, these States\n were excluded from the study. The Kentucky, New York, Oregon, and\n Utah MFCUs responded to our request; however, the data provided was\n not sufficiently complete for comparable analysis. As a result, the\n responses from these MFCUs and the corresponding State Medicaid\n agencies were excluded from this report. This study reflects responses\n from the remaining 44 States with MFCUs.\n\n We asked State Medicaid agencies to provide the number of suspected\n fraud referrals made to MFCUs; the number of those accepted for\n investigation; the number of those declined for investigation, thus\n allowing the State Medicaid agency to initiate administrative actions, as\n appropriate; and the number of those for which no investigative decision\n had been made by their MFCUs. We asked MFCUs to provide the\n number of suspected fraud referrals they received from State Medicaid\n agencies and other sources; the number of those accepted for\n investigation; the number of those declined for investigation, thus\n allowing another agency to initiate appropriate administrative action,\n as appropriate; and the number of those for which no investigative\n decision had been made. We asked the MFCUs for information on\n referrals received from State Medicaid agencies as well as those from all\n other sources for the 3-year period July 2002 through June 2005. We\n also requested the MFCUs to provide the general reasons that referrals\n were not accepted for criminal and/or civil investigation.\n\n In our requests to State Medicaid agencies and MFCUs, we did not\n define the terms referral, accept, decline, and no decision made for\n respondents. Although they are not usually defined, these terms are\n used commonly in policies and procedures governing the work for State\n Medicaid agencies and MFCUs. We provided respondents the ability to\n contact us if they had any questions about the information we\n requested.\n\n The common understanding of each of the terms is as follows:\n\n o\t Referral \xe2\x80\x93 a matter that an outside entity brings to the attention of\n a MFCU regarding suspected Medicaid fraud. \xe2\x80\x9cReferrals\xe2\x80\x9d can range\n from something that is well researched and developed to simply an\n article mentioning potential wrongdoing clipped from the\n newspaper.\n\n\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 4\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nI N T R O D U C T I O N\n\n\n o\t Accept \xe2\x80\x93 matters that the MFCU retains for further investigation.\n According to internal policy, some MFCUs accept all referrals from\n all sources. Most MFCUs, however, accept for investigation only\n those matters that meet a certain threshold (e.g., indications that a\n crime had been committed, dollar threshold for prosecution).\n\n o\t Decline \xe2\x80\x93 matters that the MFCU does not retain for further\n investigation, allowing another entity to initiate administrative\n actions, as appropriate. The term decline should not be confused\n with a declination on the part of the prosecutor to take a matter to\n court.\n\n o\t No decision made \xe2\x80\x93 matters that, at the time of our inquiry, the\n MFCU had not yet made a determination of whether to accept or\n decline.\n Limitations\n We did not review individual preliminary investigations that State\n Medicaid agencies conducted for completeness or appropriateness. We\n also did not evaluate processes MFCUs used or results achieved as part\n of their acceptance, declination, and/or development of fraud issues for a\n criminal and/or civil investigation. We collected information from State\n Medicaid agencies and MFCUs. We elected to report the referral\n numbers from MFCUs, because they receive referrals from State\n Medicaid agencies and other sources, providing a more comprehensive\n representation of their investigative workload.\n\n Some MFCU directors stated that they received suspected fraud\n referrals on the same matter from multiple sources. In such cases, the\n referral was credited to the entity that first referred the matter to the\n MFCU. Therefore, State Medicaid agencies could have referred\n additional suspected fraud issues that the MFCU would not have\n counted as a referral from them, when these issues had previously been\n received from other sources.\n\n Data presented in the report are the raw referral statistics that MFCUs\n provided and are not adjusted for such factors as State Medicaid agency\n or MFCU operating budgets, State Medicaid program expenditures,\n beneficiary and provider populations, or claims volume.\n Standards\n This study was conducted in accordance with the \xe2\x80\x9cQuality Standards for\n Inspections\xe2\x80\x9d issued by the President\xe2\x80\x99s Council on Integrity and\n Efficiency and the Executive Council on Integrity and Efficiency.\n\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 5\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\n \xce\x94 F I N D I N G S\n\nMedicaid Fraud Control Units reported receiving From July 2002 through June 2005,\na total of 13,733 suspected fraud referrals over a MFCUs reported receiving\n 3-year period, of which 29 percent came from 4,034 referrals from State Medicaid\n agencies and 9,699 referrals from\n State Medicaid agencies\n all other sources. State Medicaid\n agency referrals accounted for 29 percent of all MFCU-reported\n referrals for the 3-year study period.12 Table 1 provides referral data for\n each of the years in our review. Previous reports examining Medicaid\n suspected fraud referrals found that State Medicaid agency contribution\n to total referrals was 35 percent in 1985 (36 States reporting) and\n 25 percent in 1994 (45 States reporting).13\n\n Table 1: MFCU-Reported Fraud Referrals\n\n Referrals From State Medicaid\n Referrals From\n Review Period State Medicaid Agency Percent of\n Other Sources\n Agencies Total Referrals\n\n 2002\xe2\x80\x932003 1,161 3,040 28\n 2003\xe2\x80\x932004 1,403 3,045 32\n 2004\xe2\x80\x932005 1,470 3,614 29\n Total 4,034 9,699 29\n Source: Office of Inspector General analysis of MFCU data, 2006.\n\n\n For the 3-year period from July 2002 to June 2005, the number of\n referrals that an individual MFCU reported receiving from a State\n Medicaid agency ranged from 0 to 215 for any 1-year period and from\n 7 to 590 for all 3 years. (See Appendix A.) MFCU-reported referrals\n from other sources ranged from 0 to 379 in any 1 year and from 6 to\n 859 for all 3 years. (See Appendix B.) Eighty four percent (37/44) of\n MFCUs reported receiving less than half of all referrals from their\n respective State Medicaid agencies.\n\n MFCU-reported referrals from States varied greatly, but clustered to\n low and high ends. Twenty-one MFCUs reported receiving fewer than\n 12 referrals each from State Medicaid agencies (averaging less than\n 1 referral per month) in the last year of our study. These States were\n\n\n\n 12 State Medicaid agencies reported sending 3,930 suspected fraud referrals to MFCUs over\n the 3-year period, while MFCUs reported receiving 4,034 suspected fraud referrals from\n State Medicaid agencies over the same period.\n 13 \xe2\x80\x9cResults of Certified Fraud Control Units,\xe2\x80\x9d GAO/HRD-87-12FS, October 1986, and\n\n \xe2\x80\x9cSurveillance and Utilization Review Subsystems\xe2\x80\x99 Case Referrals to Medicaid Fraud\n Control Units,\xe2\x80\x9d OEI-07-95-00030, November 1996.\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 6\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nF I N D I N G S\n\n\n rural, urban, small, large, from all regions of the country, and included\n Arkansas (2 referrals), Connecticut (2 referrals), South Dakota\n (4 referrals), Virginia (8 referrals), and Wyoming (11 referrals). Only\n 3 MFCUs reported receiving over 100 referrals from State Medicaid\n agencies in the last year of our study: Florida (215 referrals), Arizona\n (192 referrals), and Texas (180 referrals). During the same period,\n California, the largest Medicaid program based on enrollment, reported\n 79 referrals from the State Medicaid agency.\n\n While referral data in Appendix A indicate an increase in the number of\n suspected fraud referrals overall from 1,161 in the 2002\xe2\x80\x932003 review\n period to 1,470 in the 2004\xe2\x80\x932005 review period, only 1 State Medicaid\n agency significantly contributed to this upward trend. During the\n period July 2002 through June 2005, Florida\xe2\x80\x99s reported referrals\n increased from 33 to 82 to 215 for each 12-month period, accounting for\n 59 percent (182/309) of the difference between the 2002\xe2\x80\x932003 and\n 2004\xe2\x80\x932005 reported number of referrals. In fact, more than half\n (24/44) of MFCUs actually reported receiving fewer referrals from their\n respective State Medicaid agency in the last year of our review\n compared to the average number of referrals over all 3 years. For\n 18 States, MFCUs also reported fewer referrals from other sources in\n the last year, compared to the 3-year average.\n\n\n\n Although the total number of\nOverall, State Medicaid agency contributions to\n referrals MFCUs accepted from\n total MFCU-accepted referrals remained both State Medicaid agencies and\n constant over a 3-year period, but individual other sources increased, the\n States fluctuated widely overall percentage contribution of\n accepted referrals that came from\n State Medicaid agencies remained relatively constant during our 3-year\n study period. (See Table 2 on the next page.) In contrast, the\n contributions of individual State Medicaid agencies to their respective\n MFCUs fluctuated greatly. Fifty-nine percent (26/44) of MFCUs\n reported accepting fewer referrals from their respective State Medicaid\n agency in the last year of our review, while 41 percent (18/44) reported\n an increase compared to the average number of referrals over all\n 3 years. This indicates that increases in accepted referrals are\n concentrated in less than half of the States.\n\n\n\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 7\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nF I N D I N G S \n\n\n\n\n\n Table 2: MFCU - Reported Accepted Fraud Referrals\n\n Referrals Accepted Referrals State Medicaid Agency\n Review Period From State Medicaid Accepted From Percent of Total Referrals\n Agencies Other Sources Accepted\n\n 2002\xe2\x80\x932003 748 1,694 31\n 2003\xe2\x80\x932004 964 1,780 35\n 2004\xe2\x80\x932005 1,020 2,164 32\n Total 2,732 5,638 33\n Source: Office of Inspector General analysis of MFCU data, 2006.\n\n Eight MFCUs accepted all referrals during our 3-year study period.\n (See Appendix C.) As an example, the Florida MFCU saw an increase\n in the number of referrals and accepted referrals by 182 from the first to\n last year of our study. As a result, Florida alone accounted for\n 67 percent (182/272) of increases in accepted referrals during this 3-year\n period.\n\n Twenty-six MFCUs reported accepting, on average, no more than\n one referral a month from their respective State Medicaid agencies.\n MFCU-reported accepted referrals from State Medicaid agencies ranged\n from 0 to 215 for any 1 year and from 1 to 330 for all 3 years.\n (See Appendix A.) MFCU-reported accepted referrals from all other\n sources ranged from 0 to 372 in any 1 year and from 3 to 766 for all\n 3 years. (See Appendix B).\n\n The most frequent reason that MFCUs cited for declining a referral\n from State Medicaid agencies was that the referral did not contain\n enough information to establish that a Medicaid crime had been\n committed (33 MFCUs).14 Other reasons frequently cited include\n referral to another agency for administrative action (19 MFCUs) and\n the need for additional development by the respective State Medicaid\n agency (18 MFCUs). Only 50 referrals for the full 3-year period were\n reported to us as \xe2\x80\x9cno decision made,\xe2\x80\x9d indicating that nearly all referrals\n were reviewed and were either accepted for investigation or declined,\n thus allowing the referring agency to take action it deemed appropriate.\n\n\n\n\n 14 We recognize that fraud may ultimately be determined only through a judgment by a\n court of law. MFCUs noted that some referrals did not establish the necessary elements\n to proceed with a criminal investigation.\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 8\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nF I N D I N G S\n\xce\x94 R E C O M M E N D A T I O N \n\n\n We recommended in our November 1996 report \xe2\x80\x9cSurveillance and\n Utilization Review Subsystems\xe2\x80\x99 Case Referrals to Medicaid Fraud\n Control Units,\xe2\x80\x9d OEI-07-95-00030, that CMS establish fraud referral\n performance standards for State Medicaid agencies. While CMS\n concurred with this recommendation, it has not established these\n performance standards.\n\n In the absence of CMS performance standards or criteria specific to the\n referral of suspected fraud issues, we are unable to determine the\n adequacy of State Medicaid agencies\xe2\x80\x99 performance. Such criteria would\n assist State Medicaid agencies by providing specifics concerning the\n development and referral of suspected fraud issues to MFCUs. In\n addition, such criteria would help ensure that the content and manner\n of referring suspected fraud issues is consistent across States. However,\n some reported results, such as no fraud referrals for an entire year or\n only one accepted referral over 3 years, do not appear adequate given\n the State Medicaid agencies\xe2\x80\x99 access to Medicaid claims information and\n their designated role to identify and refer suspected fraud issues to\n MFCUs.\n\n Despite the growth in Medicaid expenditures and the increased focus on\n Medicaid program integrity, 21 MFCUs reported receiving fewer than\n 12 referrals each from their respective State Medicaid agency in the last\n year of our study. More than half of MFCUs reported receiving fewer\n referrals from their respective State Medicaid agency in the last year of\n our review compared to the average number of referrals over all 3 years.\n More than half of MFCUs reported receiving an average of no more than\n one accepted referral per month from their respective State Medicaid\n agency during the period July 2002 through June 2005.\n\n Given the findings in our report and our inability to assess the adequacy\n of State Medicaid agency performance, due to the absence of referral\n criteria, we reiterate this recommendation.\n\n\n AGENCY COMMENTS\n CMS concurred with our recommendation to work towards the\n establishment of fraud referral performance standards. CMS indicated\n that it is in the process of engaging a strategic contractor to conduct a\n comprehensive State program integrity assessment. The contractor will\n be tasked with determining the measures needed to accurately assess\n the program integrity performance of State Medicaid agencies and to\n develop a national database. Once these measures are established,\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 9\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nR E C O M M E N D A T I O N\n\n\n CMS can use this information to begin collaborative work in the\n development of national performance standards. CMS intends to\n consult with OIG regarding arriving at a commonly accepted definition\n of what constitutes an accepted referral, since the definition of this term\n varies widely from State to State. CMS noted that the Deficit Reduction\n Act of 2005 provides the necessary resources to implement OIG\xe2\x80\x99s\n longstanding recommendation. CMS comments are included in their\n entirety in Appendix D.\n\n\n OFFICE OF INSPECTOR GENERAL RESPONSE\n CMS comments to the report were based on numbers contained in the\n draft report. However, after reviewing the draft report, one State\n advised OIG that it had provided OIG incorrect information in response\n to the initial data request, and it was unable to provide information that\n completely responded to our request. The State was eliminated from\n our analyses and the data presented in the report are adjusted\n accordingly. Although we still find that the number of referrals does\n increase in each year of our study, the increase is less dramatic than\n indicated in the draft report and the percentage of referrals coming from\n State agencies drops in the last year when compared to the prior year.\n\n\n\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 10\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\n\xce\x94 A P P E N D I X E S \n\n\n The information contained in Appendixes A, B, and C is presented in\n alphabetical order by State. The order is not intended to suggest any\n ranking of performance for any State Medicaid agency or MFCU.\n\n These data do not take into account factors such as State Medicaid\n agency or MFCU operating budgets, State Medicaid program\n expenditures, beneficiary and provider populations, or claims volume.\n\n Additionally, these data do not reflect the entirety of workloads for\n either the State Medicaid agencies or MFCUs. State Medicaid agencies\n pursue overpayment cases in addition to making referrals to MFCUs.\n MFCUs self-generate work in addition to receiving referrals from State\n Medicaid agencies and external sources.\n\n\n\n\nOEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 11\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\n \xce\x94 A P P E N D I X A\n\n MFCU-Reported Fraud Referral Data From State Medicaid Agencies*\n\n Referrals Received From State Referrals Accepted From State\n Totals Totals\n Medicaid Agency Medicaid Agency\n State 2002\xe2\x80\x932003 2003\xe2\x80\x932004 2004\xe2\x80\x932005 2002\xe2\x80\x932005 2002\xe2\x80\x932003 2003\xe2\x80\x932004 2004\xe2\x80\x932005 2002\xe2\x80\x932005\n Alabama 6 13 7 26 6 9 4 19\n Alaska 34 20 94 148 2 7 13 22\n Arizona 196 202 192 590 59 54 42 155\n Arkansas 59 5 2 66 21 5 2 28\n California 145 163 79 387 104 125 72 301\n Colorado 6 13 7 26 5 8 5 18\n Connecticut 45 5 2 52 26 4 2 32\n Delaware 1 7 7 15 1 7 7 15\n District of Columbia 2 5 5 12 2 4 5 11\n Florida 33 82 215 330 33 82 215 330\n Georgia 8 6 11 25 8 6 11 25\n Hawaii 3 2 2 7 3 2 2 7\n Illinois 47 90 83 220 39 49 55 143\n Indiana 11 30 35 76 11 30 35 76\n Iowa 1 2 11 14 1 0 4 5\n Kansas 11 21 47 79 11 21 45 77\n Louisiana 10 33 31 74 10 33 31 74\n Maine 8 14 19 41 8 14 19 41\n Maryland 7 11 9 27 2 8 5 15\n Massachusetts 16 6 10 32 15 5 9 29\n Michigan 24 47 26 97 17 26 18 61\n Minnesota 10 9 13 32 6 6 4 16\n Mississippi 25 11 5 41 16 6 3 25\n Missouri 25 23 20 68 25 23 20 68\n Montana 11 7 9 27 8 6 8 22\n Nevada 4 8 7 19 4 4 2 10\n New Hampshire 9 6 9 24 6 2 7 15\n New Jersey 15 21 12 48 14 19 10 43\n New Mexico 11 5 6 22 11 5 6 22\n North Carolina 14 12 18 44 14 10 12 36\n Ohio 60 97 63 220 58 90 58 206\n Oklahoma 70 67 78 215 28 32 32 92\n Pennsylvania 12 24 18 54 12 24 18 54\n Rhode Island 9 6 3 18 8 5 3 16\n South Carolina 14 12 12 38 14 11 11 36\n South Dakota 0 7 4 11 0 1 0 1\n Tennessee 11 5 30 46 6 3 5 14\n Texas 81 205 180 466 40 135 142 317\n Vermont 17 15 5 37 15 13 4 32\n Virginia 13 11 8 32 12 6 7 25\n Washington 25 13 17 55 25 13 17 55\n West Virginia 22 23 22 67 22 23 22 67\n Wisconsin 28 27 26 81 18 16 17 51\n Wyoming 2 12 11 25 2 12 11 25\n Total 1,161 1,403 1,470 4,034 748 964 1,020 2,732\nSource: MFCU reported data, 2006.\n\n*The Kentucky, New York, Oregon, and Utah MFCUs responded to our request; however, the data provided was not sufficiently complete\nfor comparable analysis.\n\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 12\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\n \xce\x94 A P P E N D I X B\n MFCU-Reported Fraud Referral Data From All Other Sources*\n\n Referrals Received From All Referrals Accepted From All\n Totals Totals\n Other Sources Other Sources\n State 2002\xe2\x80\x932003 2003\xe2\x80\x932004 2004\xe2\x80\x932005 2002\xe2\x80\x932005 2002\xe2\x80\x932003 2003\xe2\x80\x932004 2004\xe2\x80\x932005 2002\xe2\x80\x932005\n Alabama 8 15 11 34 6 12 7 25\n Alaska 72 67 34 173 11 18 3 32\n Arizona 185 185 183 553 54 46 37 137\n Arkansas 37 48 47 132 24 31 31 86\n California 182 99 166 447 165 71 114 350\n Colorado 65 46 36 147 27 21 16 64\n Connecticut 103 23 55 181 8 23 55 86\n Delaware 11 58 49 118 10 55 45 110\n District of Columbia 27 36 53 116 27 34 51 112\n Florida 193 201 372 766 193 201 372 766\n Georgia 51 58 33 142 44 53 23 120\n Hawaii 60 75 81 216 60 75 81 216\n Illinois 9 29 84 122 9 25 62 96\n Indiana 68 204 137 409 68 204 137 409\n Iowa 39 68 78 185 17 12 17 46\n Kansas 53 49 129 231 14 25 54 93\n Louisiana 51 78 83 212 32 36 38 106\n Maine 64 136 114 314 31 41 50 122\n Maryland 31 27 23 81 10 10 9 29\n Massachusetts 48 25 22 95 15 4 3 22\n Michigan 379 264 216 859 81 46 30 157\n Minnesota 18 22 15 55 11 16 11 38\n Mississippi 36 33 30 99 13 16 6 35\n Missouri 32 15 20 67 32 15 20 67\n Montana 20 26 35 81 11 12 12 35\n Nevada 78 91 85 254 17 17 18 52\n New Hampshire 20 14 16 50 13 3 9 25\n New Jersey 23 35 110 168 21 29 86 136\n New Mexico 79 41 68 188 12 10 20 42\n North Carolina 90 79 90 259 80 72 84 236\n Ohio 161 160 195 516 83 98 146 327\n Oklahoma 15 20 10 45 4 13 7 24\n Pennsylvania 36 33 33 102 36 33 33 102\n Rhode Island 2 1 3 6 2 1 3 6\n South Carolina 28 45 64 137 28 39 58 125\n South Dakota 11 9 20 40 7 4 8 19\n Tennessee 92 78 137 307 20 26 34 80\n Texas 212 290 326 828 73 96 110 279\n Vermont 67 63 94 224 50 39 46 135\n Virginia 35 18 58 111 30 18 19 67\n Washington 164 154 170 488 164 154 170 488\n West Virginia 10 12 10 32 10 12 10 32\n Wisconsin 7 1 0 8 3 0 0 3\n Wyoming 68 14 19 101 68 14 19 101\n Total 3,040 3,045 3,614 9,699 1,694 1,780 2,164 5,638\nSource: MFCU reported data, 2006.\n\n*The Kentucky, New York, Oregon, and Utah MFCUs responded to our request; however, the data provided was not sufficiently\ncomplete for comparable analysis.\n\n\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 13\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\n \xce\x94 A P P E N D I X C\n Comparison of MFCU-Accepted Fraud Referral and Contribution Rates\n Comparison of MFCU Accepted Referral and Contribution Rates*\n Percentage Contribution of Accepted Percentage of State Medicaid Percentage of Referrals From All\n Referrals From State Medicaid Agency Agency Referrals Accepted Other Sources Accepted\n State 2002-2005 2002-2005 2002-2005\n Alabama 43.2 73.1 73.5\n Alaska 40.7 14.9 18.5\n Arizona 53.1 26.3 24.8\n Arkansas 24.6 42.4 65.2\n California 46.2 77.8 78.3\n Colorado 22.0 69.2 43.5\n Connecticut 27.1 61.5 47.5\n Delaware 12.0 100.0 93.2\n District of Columbia 8.9 91.7 96.6\n Florida 30.1 100.0 100.0\n Georgia 17.2 100.0 84.5\n Hawaii 3.1 100.0 100.0\n Illinois 59.8 65.0 78.7\n Indiana 15.7 100.0 100.0\n Iowa 9.8 35.7 24.9\n Kansas 45.3 97.5 40.3\n Louisiana 41.1 100.0 50.0\n Maine 25.2 100.0 38.9\n Maryland 34.1 55.6 35.8\n Massachusetts 56.9 90.6 23.2\n Michigan 28.0 62.9 18.3\n Minnesota 29.6 50.0 69.1\n Mississippi 41.7 61.0 35.4\n Missouri 50.4 100.0 100.0\n Montana 38.6 81.5 43.2\n Nevada 16.1 52.6 20.5\n New Hampshire 37.5 62.5 50.0\n New Jersey 24.0 89.6 81.0\n New Mexico 34.4 100.0 22.3\n North Carolina 13.2 81.8 91.1\n Ohio 38.6 93.6 63.4\n Oklahoma 79.3 42.8 53.3\n Pennsylvania 34.6 100.0 100.0\n Rhode Island 72.7 88.9 100.0\n South Carolina 22.4 94.7 91.2\n South Dakota 5.0 9.1 47.5\n Tennessee 14.9 30.4 26.1\n Texas 53.2 68.0 33.7\n Vermont 19.2 86.5 60.3\n Virginia 27.2 78.1 60.4\n Washington 10.1 100.0 100.0\n West Virginia 67.7 100.0 100.0\n Wisconsin 94.4 63.0 37.5\n Wyoming 19.8 100.0 100.0\n Total (weighted) 29.4 67.8 58.3\nSource: Office of Inspector General analysis of MFCU reported data, 2006.\n\n*The Kentucky, New York, Oregon, and Utah MFCUs responded to our request; however, the data provided was not sufficiently complete for\ncomparable analysis.\n\n\n\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 14\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\n\xce\x94 A P P E N D I X D\n\n Agency Comments\n\n\n\n\nOEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 15\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nA P P E N D I X D \n\n\n\n\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 16\n\x0c Report Template Update = 04-30-05_rev.15\n\n\n\n\nA P P E N D I X ~ B\n\xce\x94 A C K N O W L E D G M E N T S\n\n\n\n This report was prepared under the direction of Brian T. Pattison,\n Regional Inspector General for Evaluation and Inspections in the\n Kansas City regional office, and Gina C. Maree, Deputy Regional\n Inspector General. Other principal Office of Evaluation and Inspections\n staff who contributed include:\n\n Brian Whitley, Team Leader\n Perry Seaton, Senior Program Analyst\n\n Zula Crutchfield, Program Analyst\n\n Linda Paddock, Program Analyst\n\n Ayana Everett, Program Specialist\n\n Elise Stein, Director, Public Health and Human Services Branch\n\n\n\n\n OEI-07-04-00181 SUSPECTED MEDICAID FRAUD REFERRALS\n 17\n\x0c"


type: wikipedia

text:
Villanueva de la Torre is a municipality located in the province of Guadalajara, Castile-La Mancha, Spain. The village has a surface of 11,09 km 2 with a population of 6321 inhabitants according to the municipal census of the year 2009 and a density of 569,97 inhabitants/km 2.
 Villanueva de la Torre es un municipio situado en la provincia de Guadalajara, Castilla-La Mancha, España. El pueblo cuenta con una superficie de 11,09 km 2 con una población de 6.321 habitantes según el padrón municipal del año 2009 y una densidad de 569,97 hab / km 2.
 Municipalities in the Province of Guadalajara


type: legislation

jurisdiction: EU

text:
 12.11.2015
 HU
 Az Európai Unió Hivatalos Lapja
 L 295/21
 A BIZOTTSÁG (EU) 2015/2017 VÉGREHAJTÁSI RENDELETE
 (2015. november 11.)
 a 2009/138/EK európai parlamenti és tanácsi irányelvnek megfelelően az euróhoz rögzített pénznemek esetében a devizaárfolyam-kockázat tőkeszükségletének kiszámításához alkalmazandó kiigazított tényezőkre vonatkozó végrehajtás-technikai standardok meghatározásáról
 (EGT-vonatkozású szöveg)
 AZ EURÓPAI BIZOTTSÁG,
 tekintettel az Európai Unió működéséről szóló szerződésre,
 tekintettel a biztosítási és viszontbiztosítási üzleti tevékenység megkezdéséről és gyakorlásáról szóló, 2009. november 25-i 2009/138/EK európai parlamenti és tanácsi irányelvre (1) (Szolvencia II.) és különösen annak 109a. cikke (2) bekezdésének c) pontjára,
 mivel:
 (1)
 Az ebben a rendeletben meghatározott kiigazítások figyelembe veszik az (EU) 2015/35 felhatalmazáson alapuló bizottsági rendelet (2) 188. cikkének (5) bekezdésében rögzített részletes kritériumokat.
 (2)
 A devizaárfolyam-kockázat tőkeszükségletének kiszámítása során az euróhoz rögzített pénznemek egységes kezelésének biztosítása érdekében kiigazított tényezőket kell meghatározni a devizaárfolyam-kockázatra vonatkozóan, az euro és az euróhoz rögzített pénznemek közötti átváltási árfolyam, valamint két, az euróhoz rögzített pénznem közötti átváltási árfolyam tekintetében.
 (3)
 Ez a rendelet az Európai Biztosítás- és Foglalkoztatóinyugdíj-hatóság által a Bizottságnak benyújtott végrehajtás-technikai standardtervezeteken alapul.
 (4)
 Az Európai Biztosítás- és Foglalkoztatóinyugdíj-hatóság nyilvános konzultációt folytatott az e rendelet alapját képező végrehajtás-technikai standardtervezetekről, elemezte az esetleges kapcsolódó költségeket és hasznot, továbbá kikérte az 1094/2010/EU európai parlamenti és tanácsi rendelet (3) 37. cikkével összhangban létrehozott biztosítási és viszontbiztosítási érdekképviseleti csoport véleményét,
 ELFOGADTA EZT A RENDELETET:
 1. cikk
 A devizaárfolyam-kockázatra vonatkozó kiigazított tényezők, ha a hazai vagy külföldi pénznem az euro
 Ha a hazai vagy külföldi pénznem az euro, az (EU) 2015/35 felhatalmazáson alapuló rendelet 188. cikke (3) és (4) bekezdésének alkalmazásában a 25 %-os tényezőt a következők váltják fel:
 a)
 0,39 %, ha a másik pénznem a dán korona (DKK);
 b)
 1,81 %, ha a másik pénznem a leva (BGN);
 c)
 2,18 %, ha a másik pénznem a CFA-frank (BCEAO) (XOF);
 d)
 1,96 %, ha a másik pénznem a CFA-frank (BEAC) (XAF);
 e)
 2,00 %, ha a másik pénznem a comore-i frank (KMF).
 2. cikk
 A devizaárfolyam-kockázatra vonatkozó kiigazított tényezők, ha a hazai vagy külföldi pénznem az euróhoz rögzített pénznem
 Az (EU) 2015/35 felhatalmazáson alapuló rendelet 188. cikke (3) és (4) bekezdésének alkalmazásában a 25 %-os tényezőt a következők váltják fel:
 a)
 2,24 %, ha a két pénznem a DKK és a BGN;
 b)
 2,62 %, ha a két pénznem a DKK és az XOF;
 c)
 2,40 %, ha a két pénznem a DKK és az XAF;
 d)
 2,44 %, ha a két pénznem a DKK és a KMF;
 e)
 4,06 %, ha a két pénznem a BGN és az XOF;
 f)
 3,85 %, ha a két pénznem a BGN és az XAF;
 g)
 3,89 %, ha a két pénznem a BGN és a KMF;
 h)
 4,23 %, ha a két pénznem az XOF és az XAF;
 i)
 4,27 %, ha a két pénznem az XOF és a KMF;
 j)
 4,04 %, ha a két pénznem az XAF és a KMF.
 3. cikk
 Hatálybalépés
 Ez a rendelet az Európai Unió Hivatalos Lapjában való kihirdetését követő huszadik napon lép hatályba.
 Ez a rendelet teljes egészében kötelező és közvetlenül alkalmazandó valamennyi tagállamban.
 Kelt Brüsszelben, 2015. november 11-én.
 a Bizottság részéről
 az elnök
 Jean-Claude JUNCKER
 (1) HL L 335., 2009.12.17., 1. o.
 (2) A Bizottság 2014. október 10-i (EU) 2015/35 felhatalmazáson alapuló rendelete a biztosítási és viszontbiztosítási üzleti tevékenység megkezdéséről és gyakorlásáról szóló 2009/138/EK európai parlamenti és tanácsi irányelv (Szolvencia II) kiegészítéséről (HL L 12., 2015.1.17., 1. o.).
 (3) Az Európai Parlament és a Tanács 2010. november 24-i 1094/2010/EU rendelete az európai felügyeleti hatóság (az Európai Biztosítás- és Foglalkoztatóinyugdíj-hatóság) létrehozásáról, valamint a 716/2009/EK határozat módosításáról és a 2009/79/EK bizottsági határozat hatályon kívül helyezéséről (HL L 331., 2010.12.15., 48. o.).