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CMS review: $566K overpaid to Geisinger Medicare Advantage plan

Posted On: Mar. 24, 2023 9:58 AM CST

The Office of the Inspector General has found that audited diagnosis codes that Geisinger Health Plan sent to the Centers for Medicare and Medicaid Services for its Medicare Advantage plan were non-compliant, resulting in $566,476 in overpayments, reports Healthpayer Intelligence. The audit found that out of the 270 enrollee-years, all but 46 enrollee-years were non-compliant. This means that either the health plan could not produce evidence for the diagnosis codes or the evidence that the health plan offered did not reinforce the diagnosis codes.