Independence Blue Cross' Keystone Health Plan East received an estimated $11.3 million in overpayments for 2016 and 2017, according to an audit from HHS' Office of Inspector General.
In an audit published May 31, the agency sampled 270 enrollee years and found $550,931 in overpayments. The agency used this sample to estimate the total $11.3 million.
OIG recommended Independence Blue Cross refund the $550,931 in overpayments and identify similar instances of noncompliance. The agency did not request the estimated $11.3 million figure because of a recent CMS ruling that audit findings cannot be extrapolated past 2018.
Independence Blue Cross did not fully agree with the agency's findings and recommendations, according to the audit.
"While the net overpayment amount of $550,391 identified by HHS-OIG represents approximately 0.026 percent of our CMS revenue for the two audited years, we take the results of the audit very seriously and will use the feedback to further enhance our processes," Independence Blue Cross said in a statement shared with Becker's.
"We are very proud of our strong compliance track record. In fact, we received a perfect score on a recent 2022 CMS Program Audit. Our Keystone 65 HMO plans have been awarded a prestigious five out of five stars for the past two years by CMS. These ratings show the high-quality of our Medicare Advantage plans," Independence Blue Cross said.
OIG audited six Medicare Advantage plans for alleged overpayments in the past six months, finding an estimated $32 million in overpayments.