Medicare Advantage overbilling resurgence

Audit with magnifying glass
Getty/cacaroot

Previously unreleased audits of Medicare Advantage plans continue to surface, adding to previous reports that insurers had inflated risk scores in order to boost reimbursement.

In August, 37 previously unreleased government audits showed that 40% of medical conditions were not confirmed by the auditors, with overpayments ranging from $2,000 to $10,000 per patient.

Meanwhile, a Florida physician accused Humana of inflating MA risk scores by upcoding the severity of patient diagnoses.

And an appeals court reopened a whistleblower’s case against four insurers alleging foul play with MA plans, breathing new life into a case that could emerge as a key turning point for those concerned about inflated risk scores.

Medicare Advantage overbilling resurgence