The agency sampled 285 unique enrollee-years with 10 high-risk diagnosis codes and found $482,601 in net overpayments. The OIG used the sample to reach the $5.1 million estimate.
The agency recommended SelectCare repay $482,601. The agency did not request the full estimated $5.1 million because of new CMS guidance issued in January that prevents the federal government from collecting extrapolated overpayments before contract year 2018.
SelectCare disagreed with some of the audit’s findings and disagreed with OIG’s methodology, according to the report. The insurer said it would consider the OIG’s recommendation to improve its compliance procedures.
Becker’s has reached out to Centene for comment and will update this article if more information becomes available.
The OIG has audited several other payers for overpayments this year, estimating they collectively received at least $82.2 million in overpayments.
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