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Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Geisinger Health Plan (Contract H3954) Submitted to CMS

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Thursday, March 16, 2023
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-09-21-03011
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
Location(s): 
US
Panama
Type of Report: 
Audit
Questioned Costs: 
$566,476
Funds for Better Use: 
$0
Number of Recommendations: 
2
View Document: 
AttachmentSize
PDF icon 92103011.pdf14.97 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
23-A-09-057.01 Open No
We recommend that Geisinger Health Plan refund to the Federal Government the $566,476 of net overpayments.
23-A-09-057.02 Open No
We recommend that Geisinger Health Plan identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before and after our audit period and refund any resulting overpayments to the Federal Government.
23-A-09-057.03 Open No
We recommend that Geisinger Health Plan examine its existing compliance procedures to identify areas where improvements can be made to ensure that diagnosis codes that are at high risk for being miscoded comply with Federal requirements (when submitted to CMS for use in CMS's risk adjustment program) and take the necessary steps to enhance those procedures.
Displaying 3 of 3 Recommendations