OIG audits Humana, Aetna for Medicare Advantage overpayments: 10 things to know

Becker's Healthcare September 26, 2024
Rylee Wilson

Subsidiaries of Aetna and Humana received millions in Medicare Advantage overpayments in 2017 and 2018, the HHS Office of Inspector General alleged in audits published Sept. 25.

The OIG estimated that Humana received $13.1 million in overpayments for one MA contract in 2017 and 2018. The audited contract served around 250,000 enrollees in 2018.

In a separate audit, the OIG estimated that HealthAssurance Pennsylvania, an Aetna subsidiary, received $4.2 million in overpayments between 2017 and 2018.

Here are 10 things to know:

1. The OIG audits Medicare Advantage plans to determine if diagnosis codes submitted to CMS are in line with federal requirements.
2. Diagnosis codes determine how much MA plans are reimbursed by CMS. Nearly...

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