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$115 million in overpayments alleged
Modern Healthcare

A subsidiary of UnitedHealth Group was accused by auditors of receiving as much as $115 million in overpayments from the CMS in 2007 by inappropriately using patient diagnosis codes to increase risk-adjusted reimbursements in the population-based insurance program Medicare Advantage.

The HHS inspector general’s audit (PDF) says the company, PacifiCare of Texas, claimed in one instance that it should receive enhanced payments for a patient with leg pain and difficulty walking because the beneficiary had a previous diagnosis for major recurrent depression. In another example, PacifiCare submitted a risk-adjusted claim involving vascular disease for a patient who was treated for dropping a heavy can on her foot.