News Briefs: OIG Finds Elevance Unit Got $59M in MA Overpayments
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Aug 23, 2024
An audit from the HHS Office of Inspector General (OIG) released on Aug. 14 found that MMM Healthcare received an estimated $59 million in net Medicare Advantage overpayments in 2017. Elevance Health, Inc. acquired the Puerto Rico-based MMM in June 2021 when MMM had more than 275,000 MA members and more than 314,000 Medicaid beneficiaries. OIG noted in its report that MMM “did not submit some diagnosis codes to CMS for use in the risk adjustment program in accordance with federal requirements.” Although the insurer received $59 million in overpayments, OIG said it recommended a refund of just $165,312, which was based on a sample of 200 enrollees, “because of federal regulations that limit the use of extrapolation in RADV [Risk Adjustment Data Validation] audits for recovery purposes to payment years 2018 and forward.” Read more
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