MMM Healthcare, a Puerto Rico subsidiary of Elevance Health, received $59 million in net Medicare Advantage overpayments for 2017, according to an audit from HHS' Office of Inspector General published Aug. 14.
Elevance did not purchase MMM until 2021. The agency sampled 200 enrollees with at least one diagnosis code that mapped to Hierarchical Condition Categories in 2017. MMM provided medical records as support for 688 HCCs associated with the enrollees. The OIG used the sample results to reach the $59 million overpayment figure.
The OIG recommended MMM repay $165,312. The agency did not request the full $59 million because of CMS guidance that prevents the federal government from collecting extrapolated overpayments before contract year 2018.
"These errors occurred because MMM's policies and procedures to prevent, detect, and correct noncompliance with CMS’s program requirements could be improved," the report said.
MMM disagreed with some of the audit's findings and disagreed with OIG's methodology. MMM also believes CMS' findings and recommendations are inconsistent with federal data accuracy requirements, the realities of risk adjustment, and other agency audits.
The OIG has audited and requested refunds from several other payers for MA overpayments.