- Texas will refund $11.05 million in overpayments to the federal government, after an HHS Office of Inspector General audit published Oct. 7 found the state incorrectly claimed millions in federal uncompensated care funding for its Medicaid program.
- HumanaChoice Medicare Advantage plan received $34.4 million in overpayments from CMS, according to an audit published Oct. 4. The audit examined diagnosis codes used to determine the risk status of Medicare Advantage enrollees. CMS pays plans based on these statuses. HumanaChoice disputed the findings of the audit.
- Highmark Senior Health Plan received an estimated $6.2 million in overpayments from CMS for Medicare Advantage beneficiaries, an audit published Oct. 3 found. OIG recommended Highmark refund the estimated overpayments. Highmark disagreed with the audit’s findings and recommendations, contesting OIG’s auditing and sampling methodologies.
- Audits published Sept. 30 of BlueCross BlueShield of Tennessee and Inter Valley Health Plan found the organizations’ Medicare Advantage plans received millions in overpayments as a result of diagnosis codes submitted to CMS that were not backed up by medical records. BCBS Tennessee agreed to refund the federal government $7.8 million.
- Medicare lost out on $2.8 million in savings in 2020 by incorrectly implementing price reductions on Medicare Part B drugs, an audit found. CMS incorrectly calculated these rates for seven drugs in 2020, resulting in millions of lost savings, the OIG said. According to the audit, CMS corrected the error but will not retroactively reduce payments already made for these drugs.
- An audit published Sept. 21 found states frequently pay capitation benefits, fees given to managed care organizations in exchange for making benefits available to Medicaid enrollees, for Medicaid beneficiaries enrolled in multiple states. The OIG said capitation payments were made for 327,497 Medicaid beneficiaries double enrolled in multiple states’ Medicaid programs in August 2020.
- Oversight changes CMS made in its system to identify patients in inpatient services successfully reduced overpayments for outpatient services these beneficiaries received, an audit found. A previous audit from 2013 to 2016 found the system edits CMS uses to identify these payments were not working properly. After the agency corrected this, Medicare only spent $3.9 million in overpayments from 2019 to 2021, a small fraction of the total overpayments paid from 2016 to 2019.
7 recent OIG audit findings
Here are seven recent findings from HHS’ oversight arm reported by or shared with Becker’s since Sept. 22.
