HumanaChoice received an estimated $27.3 million in overpayments in 2015 and 2016, according to an audit from HHS' Office of Inspector General.
The audit, published April 4, sampled 210 enrollee-years for high-risk diagnosis codes. OIG's audit found $480,295 in net overpayments in its sample.
Humana disagreed with OIG's findings and recommendations, according to the audit. The payer disputed the watchdog's audit methodology and estimated overpayments.
The agency requested Humana repay $480,295 in overpayments. The agency did not request the total amount of overpayments for the audit period, which it estimated at $27.3 million based on the sample, because of a recent CMS ruling that audit findings cannot be extrapolated past 2018.
The agency recommended Humana identify similar instances of noncompliance before or after the audit procedure and examine existing compliance procedures.
Humana disagreed with the recommendations and stated its compliance program satisfies all legal and regulatory requirements.
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.