News Briefs: HHS OIG Seeks $11M in Medicare Overpayments From Humana, Aetna

The HHS Office of Inspector General (OIG) is asking Humana Inc. and a division of CVS Health Corp.’s Aetna to refund the federal government a combined $11 million for estimated overpayments, according to two reports posted on Sept. 25. OIG is seeking $6.8 million from Humana and $4.2 million from Aetna’s HealthAssurance based on extrapolated audit findings. For the Humana audit, the agency examined a random sample of 240 enrollee-years for which Humana submitted high-risk diagnosis codes in 2017 and 2018. It found that for 202 enrollee-years, the claims submitted by Humana to CMS “were not supported by the medical records and resulted in $497,225 in overpayments.” HHS OIG performed a similar analysis for HealthAssurance and found the medical records did not support the diagnosis codes for 222 of the 269 sampled enrollee-years and resulted in $657,744 in overpayments. Humana and Aetna both disagreed with the findings, according to the report.