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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
Report Number
A-07-17-01173
Report Type
Audit
Location

MO,
United States

Number of Recommendations
3
Questioned Costs
$548,852
Funds for Better Use
$0

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
271203 No $0 $0

We recommend that Coventry Health Care of Missouri, Inc. refund to the Federal Government the $548,852 of total net overpayments.

271204 No $0 $0

We recommend that Coventry Health Care of Missouri, Inc. identify, for the diagnoses included in this report, instances of noncompliance in the enrollee-years that occurred: (1) during our audit period but were not included in our judgmental sample and (2) before and after our audit period and refund any resulting overpayments to the Federal Government.

271205 No $0 $0

We recommend that Coventry Health Care of Missouri, Inc. enhance its compliance procedures to focus on diagnosis codes that are at high risk for being miscoded by 1) educating its providers about the proper use and documentation of these diagnoses and 2) determining whether these diagnosis codes (when submitted to CMS for use in CMS's risk adjustment program) comply with Federal requirements.

Department of Health & Human Services OIG

United States