A new HHS Office of Inspector General audit report estimates that Excellus Health Plans, Inc. received Medicare Advantage overpayments totaling $515,090 for submitting unsupported diagnosis codes for payment years 2017 and 2018. The OIG is asking for a refund of $3.1 million based on the sample results. The agency noted that Excellus did not agree with its methodology or several of its findings, but “we maintain that our findings and recommendations are valid.” Excellus is currently the sixth-largest health insurer in New York, with 1,444,186 members. Approximately 10% of its members are enrolled in Medicare Advantage products.
Source: AIS’s Directory of Health Plans