Healthcare Finance News February 20, 2024
The MA insurer sampled received at least $3.7 million of net overpayments for 2017 and 2018, the OIG found.
A recent audit by the Office of the Inspector General found that a sampled Medicare Advantage organization did not comply with federal requirements for the program.
The OIG reviewed one MA organization, MediGold, and focused on seven groups of high-risk diagnosis codes submitted to the Centers for Medicare and Medicaid Services for use in CMS’s risk adjustment program.
Most of the selected diagnosis codes that MediGold submitted to CMS did not comply with federal requirements, the OIG said. Specifically, for 189 of the 210 sampled enrollee-years, the medical records that MediGold provided did not support the diagnosis codes and resulted...
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