News: Report claims CMS lax on recovering overpayments from Medicare Advantage companies

At a confidential agency briefing in August 2010, CMS officials outlined steps to recover more than $128 million in alleged 2007 overpayments from five Medicare Advantage insurer plans.

The briefing, recently released due to a Freedom of Information Act lawsuit filed by the Center for Public Integrity, pegged Florida Humana's payment error at $33.5 million, PacifiCare (a United Healthcare Washington state subsidiary) at $20.2 million, a New Jersey Aetna plan at $27.6 million, New Mexico Independence Blue Cross at nearly $34 million, and Philadelphia-region Lovelace at just under $13 million, according to a Kaiser Health News article published at HealthLeaders Media.

The original audits, reportedly could not confirm that one-third of the diseases the health plans had been paid to treat actually existed, mostly because patient records lacked “sufficient documentation of a diagnosis.” Yet, CMS recovered a mere fraction of its earlier overpayment estimates due to disagreements over the efficacy of the audits, Kaiser Health News reported. The Center for Public Integrity reported that 35 of 37 health plans CMS has audited overcharged Medicare, often by overstating the severity of medical conditions such as diabetes and depression.