Cigna-HealthSpring Life & Health Insurance Company received an estimated $6.24 million in Medicare Advantage overpayments in 2016 and 2017, according to an HHS Office of Inspector General audit published March 28.
The audit reviewed high-risk codes between 2016 and 2017. The OIG found $468,372 in overpayments from diagnosis codes not supported by medical records in the sample, which it used to estimate the health plan received $6.24 million in overpayments.
Cigna disagreed with the OIG's recommendations and findings and disputed the audit's methodology.
The agency recommended the health plan repay $468,372 to the federal government, rather than the estimated $6.2 million, because of a recent CMS ruling that audit findings cannot be extrapolated beyond 2018.
The OIG released audits of nine other Medicare Advantage plans in the last six months of 2022, according to the organization's semiannual report to Congress.