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.