Fierce Healthcare October 6, 2023
A new federal audit estimates that Aetna may have received at least $25.5 million in overpayments from Medicare Advantage in 2015 and 2016.
The Department of Health and Human Services Office of Inspector General (OIG) sampled 210 unique enrollee years, weighing whether submitted diagnostic codes complied with federal requirements. For 155 of the years studied, the records submitted by Aetna did not match with the diagnoses, according to the analysis (PDF).
That led to $632,070 in overpayments, which extrapolates out to $25.5 million overall, OIG said.
“As demonstrated by the errors found in our sample, Aetna’s policies and procedures to prevent, detect, and correct...
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