Secret Medicare Advantage Audits Reveal Significant Billing Errors

Secret Medicare Advantage Audits Reveal Significant Billing Errors Comment Email Print RSS  News Widget ShareThisJohn Castelluccio, for HealthLeaders Media , July 29, 2015Just-released audits on Medicare risk adjustments by HHS and the Department of Justice in 2008 show significant problems with billing-related risk score calculations that were used for beneficiaries of plans operated by Aetna Health, Independence Blue Cross of Pennsylvania, and Care Plus, a division of Humana.This article originally appeared in Physician Practice InsiderThe release earlier this month of secret Medicare Advantage audits CMS conducted on several major health insurers revealed the insurers were overpaid by more than $3.3 million in 2007. It may have been solely due to inadvertent billing errors and inflated risk scores as opposed to intentional fraud, but it’s unclear because the regulators aren’t talking.The audits, which were conducted in 2008 on at least five insurers across the country as part of a larger investigation on Medicare risk adjustments by HHS and the Department of Justice, showed significant problems with billing-related risk score calculations that were used for beneficiaries who joined a Medicare Advantage plan.

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