Healthcare News: OIG coding audit says that Humana health overcharged Medicare $200 million

Why This Topic Matters

It highlights how diagnosis coding documentation can affect Medicare Advantage payment integrity and why audit scrutiny of risk adjustment data matters to health plans, compliance teams, and coding professionals.

Article Sections

1. Audit background and prior findings

   Introduces the audit context, including prior OIG work on Medicare Advantage diagnosis coding and the broader focus on risk adjustment review.

2. Review methodology and sample analysis

   Summarizes the audit approach, the sampled enrollees, and the use of medical record review by an independent contractor.

3. Findings and financial impact

   Describes the audit findings, the categories of HCCs reviewed, and the payment impact reported by the OIG.

4. OIG recommendations and Humana response

   Covers the OIG’s recommended corrective actions and Humana’s disagreement with the findings, methodology, and proposed repayment amount.