Exclusive: With Extrapolation, OIG Audits Reveal $800M in Medicare Advantage Overpayments

  • Nov 07, 2024

    Based on a review of select diagnosis codes submitted by Medicare Advantage plans for risk-adjusted reimbursement dating back to 2015, the HHS Office of Inspector General (OIG) estimates that 34 MA contracts received at least $801.3 million in overpayments from the federal government, according to an analysis from AIS Health, a division of MMIT. That amount is based on extrapolation, a concept that has been challenged by Humana Inc. as it applies to separate Risk Adjustment Data Validation (RADV) audits conducted by CMS. Nevertheless, a CMS spokesperson tells AIS Health that the agency “in the next few months” will begin collecting enrollee-level improper payments identified in HHS-OIG RADV audits. Read more
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  • Lauren Flynn Kelly

    Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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