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Date Issued
Submitting OIG
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Report Number
A-09-20-03009
Report Type
Audit
Agency Wide
Yes
Number of Recommendations
0
Questioned Costs
$0
Funds for Better Use
$0
Hide this report from display
Yes

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
22-A-09-08501 No $1,890,855 $0

We recommend that Regence BlueCross BlueShield of Oregon refund to the Federal Government the $1,890,855 of estimated net overpayments.

22-A-09-08502 No $0 $0

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

22-A-09-08503 No $0 $0

We recommend that Regence BlueCross BlueShield of Oregon continue to 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.

Department of Health & Human Services OIG

United States