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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Components
Centers for Medicare and Medicaid Services
Report Number
A-03-19-00001
Report Type
Audit
Location

PA,
United States

Number of Recommendations
3
Questioned Costs
$6,227,005
Funds for Better Use
$0
External Entity
Highmark Senior Health Company

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
22-A-03-113.01 No $6,227,005 $0

We recommend that Highmark Senior Health Company refund to the Federal Government the $6,227,005 of estimated net overpayments;

22-A-03-113.02 No $0 $0

We recommend that Highmark identify, for the high-risk diagnoses included in the report, similar instances of noncompliance that occurred before or after our audit period and refund any resulting overpayments to the Federal Government.

22-A-03-113.03 No $0 $0

We recommend that Highmark continue its examination of its existing compliance procedures to identify areas where improvements can be made to ensure 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.

Department of Health & Human Services OIG

United States