News Briefs

Humana Inc. received at least $197.7 million in net overpayments in 2015 because some of the diagnosis codes it submitted as part of the Medicare Advantage risk adjustment program were not supported by patients’ medical records, estimates a new report from the HHS Office of Inspector General (OIG). The watchdog agency recommended that Humana “enhance its policies and procedures to prevent, detect, and correct noncompliance with federal requirements for diagnosis codes that are used to calculate risk-adjusted payments.” The insurer, however, disagreed with the OIG’s findings and its recommendations, writing that a draft version of the report “reflects misunderstandings related to certain statistical and actuarial principles, and legal and regulatory requirements” underlying the Medicare Advantage program. Read the report at https://bit.ly/3xjvO80.

Oscar Health, Inc., and Cigna Corp. said on April 21 that they are expanding their co-branded small-business plans to Connecticut starting July 1. The plans will feature benefits such as free virtual urgent care, $3 copays for the most commonly prescribed prescriptions and access to Cigna’s behavioral health network “for mental health resources and step-tracking rewards.” Previously, the two firms’ small-business plans were available only in Atlanta, Tennessee and certain California counties. On April 20, the startup insurer launched +Oscar, which it describes as a “tech-driven platform business” aimed at helping payers and providers engage members, drive administrative efficiency and manage medical costs. Read more at https://bit.ly/2RPLnUw and https://bit.ly/3gxkBKS.

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AIS Health Staff

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