In what the Health and Human Services Office of Inspector General is calling the largest audit penalty every imposed on a Medicare Advantage company, the feds have recently completed and an audit and are calling on the company to pay over $200 million back in Medicare overpayments. The audit results stem from the feds claiming the business received payments for claims that included overstatements of how sick patients were in 2015.
The Medicare Advantage company facing the allegations, Humana, has taken issue with the audit and is disputing the findings.
How can a business dispute a federal audit?
The findings are not final. The target company has the opportunity to appeal the results of the audit. These appeals are important for a number of reasons. In addition to the potential to benefit your business directly by defeating the audit claims, it can also work to hold the government accountable for what America’s Health Insurance Plans (AHIP) calls “fatally flawed’ for its use of extrapolation to determine payment errors.
Is this the beginning of a new trend?
The feds have made their focus on auditing the use of Medicare Advantage very clear. Multiple government agencies have dug into how companies are billing this program and will pursue charges if anything appears out of line. Feds have claimed that the program is egregiously abused and have estimated that in 2019 alone the program paid out over $16 billion in improper claims.
As a result, businesses who use this program are wise to conduct an internal audit to make sure their billing practices are in line with federal expectations. Again, any business facing allegations of wrongdoing or a bill from an audit can appeal the process.