The OIG audited medical coding records for diagnoses considered “high-risk” for upcoding. Medicare Advantage plans have faced allegations of upcoding members’ medical records to make them appear sicker, thereby receiving more payments from CMS.
Here are the audits, published between April and September 2022, summarized in the semiannual report. The audits found over $72 million in total overpayments.
1. People’s Health Network
The Louisiana-based payer received $3.3 million in overpayments in 2015 and 2016, OIG said.
2. Cariten Health Plan
The Humana subsidiary received $9.9 million in overpayments in 2016 and 2017, the agency said.
3. WellCare of Florida
According to OIG audits, the Centene subsidiary received $3.5 million in overpayments in 2015.
4. Cigna HealthSpring of Florida
The plan received $39,612 in overpayments in 2015, OIG said.
5. Regence BlueCross BlueShield of Oregon
The Portland-based payer received an estimated $1.8 million in overpayments in 2015 and 2016, according to audits.
6. Inter Valley Health Plan
The now-defunct California-based payer received at least $5.3 million in net overpayments for 2015, OIG said.
7. BlueCross BlueShield of Tennessee
The Chattanooga, Tenn.-based payer received $7.8 million in overpayments in 2016 and 2017, according to audits.
8. Highmark Senior Health Company
Highmark received at least $6.2 million in overpayments in 2015 and 2016, OIG said.
9. HumanaChoice
The plan received an estimated $34.4 million in 2016 and 2017, according to audits.
Read the full report here.
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