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