Becker's Healthcare November 10, 2023
The federal government is ramping up scrutiny of Medicare Advantage plans.
In October, the Cigna Group reached a $172 million settlement with the federal government to resolve allegations that it violated the False Claims Act by submitting incorrect Medicare Advantage patient data to CMS to receive higher payments from the agency.
HHS’ Office of the Inspector General has audited several health plans in recent months for overpayments, estimating a Humana subsidiary received $117 million in overpayments in 2015.
Melissa James, a senior consultant for health language at Wolters Kluwer, told Becker’s government scrutiny of Medicare Advantage plans is “absolutely” increasing.
“There’s lots of evidence for that. The rate and types of audits are increasing. CMS will very...
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