November 21, 2022
  • A Kaiser Health News (KHN) investigation found that government audits of payments to Medicare Advantage plans show that there were about $12 million in overpayments in a sample of 18,090 patients. According to the investigation, the Centers for Medicare & Medicaid Services (CMS) has only conducted 90 audits over the past decade. Of those, 71 uncovered net overpayments, which topped $1,000 per patient on average in 23 audits. Humana had overpayments exceeding that $1,000 average in 10 of 11 audits. CMS paid the remaining plans too little on average, anywhere from $8 to $773 per patient. CMS plans to extrapolate the payment errors and recoup about $650 million. (Article here)