News: OIG audit of CarePlus Health reveals overpayment of $117.3 million

CDI Strategies - Volume 17, Issue 49

The Office of Inspector General (OIG) recently completed an audit of CarePlus Health Plans, Inc., finding that 466 out of the 1,656 hierarchical condition category (HCC) codes reviewed could not be validated, according to a federal press release.

The audit was conducted to establish whether CarePlus collected and submitted its enrollee’s diagnostic codes in line with federal regulations. The OIG selected a sample of 200 CarePlus enrollees with at least one reported HCC for 2015. According to the OIG, CarePlus provided medical records for the 1,656 HCCs associated with the enrollees.

In its investigation, the OIG found that the medical records CarePlus provided validated 1,210 of the 1,656 sampled enrollees’ HCCs; however, the remaining 466 HHCs were not validated, resulting in overpayments. As a result, the OIG estimated that CarePlus received an excess of $117.3 million in overpayments for the year 2015.

Editor’s note: To read the OIG press release, click here. To read the full report, click here.

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