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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-01-19-00500
Report Type
Audit
Location

MA,
United States

Number of Recommendations
3
Questioned Costs
$3,758,335
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
22-A-01-039.01 No $3,758,335 $0

We recommend that Tufts Health Plan refund to the Federal Government the $3,758,335 of net overpayments.

22-A-01-039.02 No $0 $0

We recommend that Tufts Health Plan 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-01-039.03 No $0 $0

We recommend that Tufts Health Plan continue to improve 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