Independence Blue Cross’ Keystone Health Plan East reportedly received $11.3 million in overpayments for 2016 and 2017, according to an audit by the HHS Office of Inspector General. The audit sample found $550,931 in overpayments, and the agency recommended a refund for that amount. Independence Blue Cross disagreed with the findings but acknowledged the audit’s significance. The OIG has audited six Medicare Advantage plans in the past six months, uncovering around $32 million in overpayments.
Independence Blue Cross’ Keystone Health Plan East has been identified as receiving an approximate sum of $11.3 million in overpayments for the years 2016 and 2017, as indicated in an audit conducted by the Office of Inspector General (OIG) under the U.S. Department of Health and Human Services (HHS).
Published on May 31, the audit report reveals that a sample of 270 enrollee years was examined, uncovering $550,931 in overpayments. This sample was then used to estimate the total amount of $11.3 million.
As a result of their findings, the OIG has recommended that Independence Blue Cross reimburse the identified amount of $550,931 in overpayments and take measures to identify any additional instances of noncompliance. However, the estimated $11.3 million figure was not pursued by the agency due to a recent ruling by the Centers for Medicare & Medicaid Services (CMS), which restricts the extrapolation of audit findings beyond 2018.
Independence Blue Cross, however, did not fully concur with the findings and recommendations presented in the audit report, as stated in their response to the OIG’s assessment. They acknowledged the net overpayment amount of $550,391 identified by the HHS-OIG, clarifying that it accounts for approximately 0.026 percent of their CMS revenue for the audited years. The organization emphasized its commitment to addressing the audit results seriously and using the feedback received to further enhance their operational processes.
Independence Blue Cross also highlighted its strong compliance track record, citing a perfect score on a recent CMS Program Audit in 2022. They emphasized that their Keystone 65 HMO plans have consistently achieved a prestigious five out of five stars rating by CMS for the past two years, illustrating the high quality of their Medicare Advantage plans.
The OIG’s audit encompassed a total of six Medicare Advantage plans over the past six months, investigating potential overpayments. Their findings indicate an estimated total of $32 million in overpayments across the audited plans.
