News: UnitedHealthcare received $3.7 billion in 2017 in questionable MA payments

CDI Strategies - Volume 15, Issue 49

A previous OIG analysis asserted that 20 organizations were responsible for $5 billion in risk-adjusted Medicare Advantage overpayments through improper billing practices. The agency further blamed one insurer for 40% of all of the improper billing, though the mentioned insurer covered only 22% of Medicare Advantage beneficiaries.

In its initial report, the OIG didn’t name that insurer. However a recent article in the Minneapolis Star Tribune, named UnitedHealthcare as the insurer in question. UnitedHealthcare, according to the article, received $3.7 billion in 2017 by leveraging risk assessments and chart reviews to drive higher payments.

In a statement, UnitedHealthcare called the findings “misleading,” claiming the OIG report is “based on old data” that is “inaccurate,”, resulting in an “attack on the CMS payment system.”

Based on the findings, investigators recommend CMS takes action to determine the appropriateness of payments to UnitedHealthcare.

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


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