Government audits find extensive Medicare Advantage overcharges

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

Megan Combs

Megan Combs was Associate Editor of I Advance Senior Care / Long Term Living from 2013-2018.