OIG Report Appears to Indicate that Medicare Advantage Organization, Humana, Inc. May Be Significantly Underpaying Downstream Contracted Providers in Global Risk Capitation Arrangements

PROVIDER ALERT By: Jason N. Silberberg, Esq. and Jonathan E. Levitt, Esq. Following the release of an April 16, 2021 HHS Office of Inspector General (“OIG”) report entitled “Medicare Advantage Compliance Audit of Diagnosis Codes that Humana, Inc. (Contract H1036) Submitted to CMS” (the “OIG Report”), headlines

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Risk-Adjusted Health Plan Audit Reveals Overpayments and Underpayments

A risk-adjusted Medicare-Advantage health plan operated by Humana was determined by an OIG audit1 to have improperly collected excess risk adjustment payments totaling nearly $200 million in 2015 by overstating as well as understating how sick some patients were. (Download the report here) Unlike Original Medicare, which pays

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