$47M Refund Sought from UnitedHealthcare Over Medicare Advantage Payments

UnitedHealthcare is being asked to repay $47 million in Medicare Advantage overpayments after a federal audit found that the company's risk-adjustment payments were not supported by medical records. The Office of Inspector General (OIG) at the U.S. Department of Health and Human Services conducted an investigation into UnitedHealthcare's practices, which are similar to those used by other health insurers.

The OIG review focused on 250 cases where UnitedHealthcare obtained risk-adjustment payments in 2020 and 2021. In these cases, the company provided medical records to justify selected diagnosis codes for 247 of them. However, auditors found that in 183 instances, these codes were not supported by the records.

UnitedHealthcare rejected the audit's findings, stating that its methodology was flawed and that it had followed Medicare rules on risk-adjustment payments. The company argued that the OIG should improve its auditing process to ensure more accurate results. UnitedHealth Group, the parent company of UnitedHealthcare, is Minnesota's largest company and has operations in various sectors including medical clinics and pharmacy benefits management.