Skip to main content
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-03-20-00001
Report Type
Audit
Location

PA,
United States

Number of Recommendations
4
Questioned Costs
$550,391
Funds for Better Use
$0
External Entity
Keystone Health Plan East, Inc.

Open Recommendations

This report has 4 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
23-A-03-082.01 No $550,391 $0

We recommend that Keystone Health Plan East, Inc. refund to the Federal Government the $550,391 in overpayments.

23-A-03-082.02 No $0 $0

We recommend that Keystone 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.

23-A-03-082.03 No $0 $0

We recommend that Keystone continue its examination of existing compliance procedures to identify areas in which 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.

23-A-03-082.04 No $0 $0

We recommend that Keystone ensure that it collects, for audits of risk adjustment data, medical records that comply with CMS requirements.

Department of Health & Human Services OIG

United States