HCC Blog by Caridad

 From the email Office of Inspector General (OIG) newsletter covering 2024 Nationwide Health Care Fraud Enforcement Action: The OIG reviewed Independent Health Association, Inc. (IHA) (Contract H3362). OIG concluded that most of the selected diagnosis codes submitted by IHA were submitted to the Centers for Medicare & Medicaid Services (CMS) for use in CMS’s risk adjustment program did not comply with Federal requirements. This resulted in $646,217 in overpayments The audit covered the enrollee-years for 2016 and 2017. OIG performed audit work from September 2019 through June 2024.  The OIG concludes that as they found errors in their sample, IHA’s policies and procedures to prevent, detect, and correct noncompliance with CMS’s program requirements, as mandated by Federal regulations, could be improved. IHA disagreed with some of the findings, specifically the findings for 17 of the 232 enrollee-years. They did not agree with the audit methodology, use of extrapolation and...

  Congressional Testimony: The Honorable Christi A. Grimm, Inspector General for the U.S. Department of Health and Human Services, testifies before the United States House Committee on Energy and Commerce, Subcommittee on Oversight and Investigations: "Examining How Improper Payments Cost Taxpayers Billions and Weaken Medicare and Medicaid.”   Watch the Testimony Video  https://www.youtube.com/watch?v=UpquPVaQrH8 Read the Testimony  https://oig.hhs.gov/documents/testimony/9865/ig-grimm-testimony-04162024.pdf Interesting time stamps: 36:07 opening statement Krisiti Grimm on Improper payments 46:45 Opening statement Dr. Chernew, chair of Medicare Payment Advisory Commission (MedPAC) 55:02 Mr. Griffith statements and question to Ms. Grimm 55:30 Krisiti Grimm response 57:41 question on how medicare advantage payments are calculated, enrollee risk score calculations and calculation of coverage payments 1:00:43 question of Ms. Grimm – reporting requirements ...