Medicare Advantage overpayments
Newly released Medicare Advantage plan audits for a sample of 2007 patients show government officials cited 35 of 37 plans they reviewed for overcharging. This chart shows the original amount each plan was paid in 2007, the adjusted amount auditors determined should have been paid, and the alleged net overpayment. Many plans have appealed the findings. Two health plans, Group Health Cooperative in Washington State and a Kaiser Foundation Health Plan in California had no net overpayment.
| Medicare Advantage Organization | Original payment | Adjusted payment after audit | Alleged overpayment |
|---|---|---|---|
| Care Plus Health Plan | $3,429,825 | $2,952,590 | $477,235 |
| Aetna Health, Inc. | $3,595,232 | $2,642,285 | $952,947 |
| Lovelace Health Plan, Inc. | $2,659,880 | $2,147,698 | $512,182 |
| Independence Blue Cross | $4,125,138 | $3,072,780 | $1,052,358 |
| PacifiCare of Washington, Inc. | $3,795,527 | $3,413,751 | $381,776 |
| Aetna Health. Inc. | $1,290,423.18 | $817,082.24 | $473,340.49 | California Physicians' Service | $479,233.90 | $173,185.24 | $306,048.66 |
| Capital District Physicians' Health Plan, Inc. | $449,810.70 | $234,899.28 | $214,911.42 |
| Coventry Health Care Inc. | $555,563.23 | $179,316.87 | $376,246.36 |
| Coventry Health Care Inc. | $1,541,796.52 | $1,212,741.04 | $329,055.48 |
| Elderplan, Inc. | $991,572.64 | $186,509.92 | $805,062.71 | EmblemHealth, Inc. | $711,180.22 | $181,399.28 | $529,780.94 |
| Gundersen Lutheran, Inc. | $1,060,455.68 | $1,037,319.44 | $23,136.23 |
| Health Alliance Medical Plans | $419,104.77 | $169,629.76 | $249,475.02 |
| Health First | $312,498.60 | $229,146.88 | $83,351.72 |
| Health Net, Inc. | $283,124.99 | $198,619.67 | $84,505.32 | Health Net, Inc. | $402,057.13 | $173,397.17 | $228,659.96 |
| HealthSpring, Inc. | $239,603.03 | $140,916.40 | $98,686.63 |
| Humana, Inc. | $1,411,837.62 | $1,033,920.08 | $377,917.54 |
| Humana, Inc. | $1,573,362.98 | $1,226,863.91 | $346,499.07 |
| Humana, Inc. | $1,338,341.14 | $958,058.03 | $380,283.11 | Humana, Inc. | $1,615,603.87 | $1,382,758.75 | $232,845.12 |
| Humana, Inc. | $1,381,264.27 | $1,112,653.17 | $268,611.10 |
| McKinley Life Insurance Co. | $1,311,392.23 | $1,162,011.30 | $149,380.93 |
| SCAN Health Plan, Inc. | $422,148,63 | $159,161.88 | $262,986.75 |
| TAHMO, Inc. | $1,756,322.89 | $1,100,193.58 | $656,129.30 | UAB Health System | $337,365.34 | $244,548.35 | $92,816.99 |
| UnitedHealth Group, Inc. | $1,419,989.04 | $1,057,461.58 | $362,527.46 |
| UnitedHealth Group, Inc. | $1,547,340.51 | $1,140,602.31 | $406,738.20 |
| Universal American Corp. | $500,592.06 | $239,801.10 | $260,790.96 |
| WellCare Health Plans, Inc. | $427,923.67 | $168,123.86 | $259,799.82 | Wellpoint, Inc. | $198,808.02 | $158,638.56 | $40,169.46 |
| Wellpoint, Inc. | $424,443.05 | $85,813.02 | $338,630.03 |
| Wellpoint, Inc. | $1,221,681.02 | $1,069,341.63 | $152,339.39 |
| Wellpoint, Inc. | $1,319,628.71 | $1,141,488.98 | $178,139.73 |
Source: Centers for Medicare and Medicaid Services Risk Adjustment Data Validation audits