Medicare Advantage Insurers Accused of Overcharging $180M

The US government's Office of the Inspector General has accused two of the largest Medicare Advantage (MA) insurers, Humana and UnitedHealthcare, of overcharging the government nearly $180 million in 2020 and 2021.

Audit findings revealed that the companies submitted diagnosis codes to Medicare that weren't backed up by medical documentation, generating an extra $131 million and $47 million in reimbursement for HumanaChoice and UnitedHealthcare of Wisconsin, respectively.

The HHS OIG suggested that the insurers refund the estimated overpayments to the CMS and improve their compliance procedures to ensure they're not submitting unsupported codes. However, both companies disputed the audit's methodology and refused to return the funds.