News: OIG analysis finds 20 MA organizations are potentially responsible for $5 billion in over payments

CDI Strategies - Volume 15, Issue 44

Twenty Medicare Advantage (MA) organizations (12%) shown to have disproportionally high payments, were reportedly responsible for more than half of the $9.2 billion total risk-adjusted payments in the year 2017, according to analysis from the OIG, which evaluated plans to see if they were using chart reviews and health risk assessments to obtain higher payments at a greater rate than appropriate.

While most insurers had a proportional amount of risk-adjusted payments based on their size, these 12% were responsible for less than one third of all MA members. The payments were created by chart reviews “that were the sole source of diagnoses in the encounter data.”

One company that has, as of now, remained unnamed by the OIG is responsible for 40% of risk-adjusted payments in the analysis but only enrolled 22% of MA members.

This analysis continues OIG scrutiny of MA insurers such as Humana, Anthem, and Aetna.

Editor’s note: The full OIG analysis can be found here. More ACDIS coverage of OIG audits can be found here.

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