OIG: Presbyterian Health Plan received estimated $2.2M in Medicare Advantage overpayments

Presbyterian Health Plan received an estimated $2.2 million in Medicare Advantage payments in 2017 and 2018, according to an audit from HHS' Office of the Inspector General. 

The audit results were published Aug. 4 and sampled 211 enrollee-years for seven high-risk diagnosis codes. The audit sample found $442,454 in overpayments. OIG used the audit sample to calculate the $2.2 million estimate. 

The agency requested $1.3 million in repayments from Presbyterian, because of a recent CMS ruling that audit findings cannot be extrapolated past 2018. 

Presbyterian Health Plan did not concur with OIGs findings. In its response to the audit, the plan said OIG overstated the amount of overpayments, and used a flawed audit process and methodology. 

OIG has audited five other Medicare Advantage plans in 2023, finding $56 million in estimated overpayments. 

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