According to the agency’s fall semiannual report, the agency issued 65 audits with an expected $82.7 million in recoveries between April and September 2023.
The agency did not request the full estimated repayment amounts from the MA plans it audited in 2023 because of a CMS ruling that prevents the agency from extrapolating payments before contract year 2018.
Here are 10 plans audited by CMS in 2023:
- Geisinger Health Plan
Received an estimated $6.5 million in overpayments in 2016 and 2017.
- MCS Advantage
Received an estimated $6.2 million in net overpayments in 2016 and 2017.
- Cigna HealthSpring Life & Health Insurance Company
Received an estimated $6.24 in estimated overpayments in 2016 and 2017.
- HumanaChoice
Received an estimated $27.3 million in net overpayments in 2015 and 2016.
- Keystone Health Plan East (Independence Blue Cross)
Received an estimated $11.3 million in overpayments in 2016 and 2017.
- Excellus Health Plan
Received an estimated $5.4 million in overpayments in 2017 and 2018.
- Presbyterian Health Plan
Received an estimated $2.2 million in overpayments in 2017 and 2018.
- Aetna
Received an estimated $25.5 million in overpayments in 2015 and 2016.
- CarePlus Health Plans (Humana)
Received an estimated $117.3 million in overpayments in 2015.
- SelectCare of Texas (Centene)
Received an estimated $5.1 million in overpayments in 2015 and 2016.
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