Tufts Health Plan received $3.7 million in Medicare Advantage overpayments, the HHS Office of Inspector General announced Feb. 14.
The audit analyzed 212 enrollee-years between 2015 and 2016 involving high-risk diagnostic codes. It found that 154 enrollee-years did not have diagnostic codes supported by medical records, resulting in overpayments.
The office recommended Tufts Health Plan pay $4 million to correct the overpayments and identify similar instances of noncompliance.
However, the payer did not agree with the findings or recommendations. It said it had already corrected five enrollee-years in the past, but did not comment on how the remaining 154 enrollee-years were erroneous.
After reviewing the payer's response and considering the five enrollee-years already corrected, the Office of Inspector General adjusted the initial $4 million figure to $3.7 million.