News: OIG investigates Aetna in its latest round of audits

Following a report from the Office of Inspector General (OIG) earlier this year showing an increase of Medicare billing for high-level inpatient stays over the past six years, the government entity has begun targeting some large insurance payers for audits.

The OIG audited Humana in April, finding the payer had overcharged Medicare by nearly $200 million in 2015 by incorrectly billing for high severity HCCs. In May, Anthem was audited by the agency and found to owe $3.47 million for unsubmitted diagnosis codes. Recently at the beginning of August, the OIG intervened in six False Claims Act suits against Kaiser Permanente.

Most recently, the OIG is auditing Aetna. CVS Health, Aetna’s parent company, noted in the filing that it may also have to refund for Medicare Advantage similar to other insurance companies. At this time, there is no information on any OIG findings for the Aetna audit.

Editor’s note: A financial filing with the Securities and Exchange Commission disclosed the OIG was looking at Aetna’s Medicare Advantage business. That filing can be found here.