OIG

HHS AUDIT FINDS THAT THE MEDICARE PROGRAM OVERPAID CIGNA-HEALTHSPRING OF TENNESSEE $5.9 MILLION DUE TO CIGNA’S SUBMISSION OF PATIENT DIAGNOSIS CODES NOT SUPPORTED BY MEDICAL RECORDS

The Office of the Inspector General for the Department of Health and Human Services (“OIG”) has issued a report of its audit of Cigna-HealthSpring of Tennessee’s (“Cigna”) submission of diagnosis codes for its Medicare Advantage members to CMS, which entitled Cigna to additional risk adjustment payments under the Medicare program.  The OIG found that the …

HHS AUDIT FINDS THAT THE MEDICARE PROGRAM OVERPAID CIGNA-HEALTHSPRING OF TENNESSEE $5.9 MILLION DUE TO CIGNA’S SUBMISSION OF PATIENT DIAGNOSIS CODES NOT SUPPORTED BY MEDICAL RECORDS Read More »

AMA ARTICLE HIGHLIGHTS OIG FINDINGS THAT MEDICARE ADVANTAGE PLANS DELAY AND DENY PATIENTS’ ACCESS TO CARE

In an article entitled How Medicare Advantage plans wrongly deny prior auth requests, the American Medical Association highlights findings from a recent Department of Health and Human Services Office of the Inspector General Report. The OIG Report found that 13% of the sampled prior authorization requests denied by Medicare Advantage plans met Medicare’s clinical coverage …

AMA ARTICLE HIGHLIGHTS OIG FINDINGS THAT MEDICARE ADVANTAGE PLANS DELAY AND DENY PATIENTS’ ACCESS TO CARE Read More »

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