MediGold, the Medicare Advantage subsidiary of Livonia, Mich.-based Trinity Health, received an estimated $3.7 million in net Medicare Advantage overpayments in 2017 and 2018, according to an audit from HHS' Office of Inspector General published Feb. 16.
The agency sampled 210 unique enrollee-years with high-risk diagnosis codes and found $469,907 in net overpayments. The OIG used the sample to reach the $3.7 million estimate.
The agency recommended MediGold repay $2.2 million. The agency did not request the full estimated $3.7 million because of CMS guidance that prevents the federal government from collecting extrapolated overpayments before contract year 2018.
MediGold disagreed with some of the audit's findings and disagreed with OIG's methodology, use of extrapolation, standards for data accuracy, and medical record review process, according to the report.
"After reviewing MediGold's comments and the additional information MediGold provided, we reduced the number of enrollee-years in error and revised the amount in our first recommendation," the OIG wrote, while maintaining that its other recommendations are valid.
Becker's has reached out to Trinity for comment and will update this article if more information becomes available.
The OIG has audited and requested refunds from several other payers for MA overpayments over the last year.