A recent HHS audit estimated that Aetna received an estimated $25.5 million in Medicare Advantage overpayments for 2015 and 2016.
The audit, conducted by the U.S. Department of Health and Human Services’ Office of Inspector General, analyzed seven groups of diagnosis codes that were at a high risk of being miscoded. Inspectors determined medical records didn’t support the codes for 155 of the 210 sampled enrollee-years, resulting in $632,070 in overpayments. Based on the sample results, inspectors concluded that Aetna received at least $25.5 million in overpayments for 2015 and 2016.
Last week, diagnostic codes were also at the center of a lawsuit against Cigna, with the insurer agreeing to pay $172 million to resolve allegations that it submitting false Medicare Advantage diagnostic codes.
Source: More Medicare Advantage fraud? Aetna received $25.5M in overpayments, says HHS / Benefits Pro