Medicare Advantage Compliance report from OIG 2022 - SCAN

An audit summary report from the Office of Inspector General (OIG)

Medicare Advantage Compliance Audit of Diagnosis Codes That SCAN Health Plan Submitted to CMS

Date of report 02/03/2022

For this audit the OIG reviewed the diagnosis codes submitted by SCAN Health Plan from claims from 2015. Yes, the review was on claims for the year 2015.

Highlights from the report include:

Sample set was 200 enrollees.

Per the OIG, 164 HCCs were not validated and resulted in overpayments

The OIG estimated that SCAN received at least $54.3 million in net overpayments for 2015.

SCAN disagreed with their findings and after review the OIG revised the number of un-validated HCCs and changed the recommended refund amount due by SCAN. 

The link to the report is found:

Medicare Advantage Compliance Audit of Diagnosis Codes That SCAN Health Plan (Contract H5425) Submitted to CMS (hhs.gov)

https://oig.hhs.gov/oas/reports/region7/71701169.asp

Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.