The audit, published Dec. 22, surveyed 10 groups of diagnosis codes at high risk for upcoding. In the sample, according to OIG, the payer received $509,194 in overpayments. OIG then used the sample to estimate the payer owes $5.9 million in refunds to the federal government.
Cigna did not concur with OIG’s recommendations or findings and disputes OIG’s audit methodology.
The watchdog office audited nine other Medicare Advantage plans in the last six months of 2022 for alleged overpayments. Medicare Advantage plans have faced allegations of upcoding patients’ diagnoses to make them appear sicker than they are, thereby receiving more money from CMS.
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