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Government audits find extensive Medicare Advantage overcharges

July 13, 2015
by Megan Combs, Associate Editor
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Government audits of Aetna, Independence Blue Cross, Lovelace Health, PacifiCare and Care Plus (a division of Humana), show widespread evidence of Medicare Advantage plan overcharges, sometimes more than $1,000 a year for some patients. The Center for Public Integrity published these audits last week.

"In all five audits, two sets of auditors inspected medical records for a sample of 201 patients at each plan for 2007," the Center for Public Integrity reports. "If the medical chart didn’t document that a patient had the illnesses the plan reported, Medicare asked for a refund. Auditors also gave plans credit for underpayments they discovered."

In the sample, Medicare paid the wrong around for 654 of the patients, which is an error rate of about two-thirds. The payments were too high for 579 patients and too low for 75, the report said. The total erroneous payment hit $3.3 million.

None of the health plans listed would discuss the audit findings with the Center.

Read more of the audit findings here.

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Aetna's Humana acquisition will swell its Medicare Advantage business