HHS OIG audits flag Humana, UnitedHealthcare MA upcoding

The HHS Office of Inspector General released audits showing HumanaChoice and UnitedHealthcare of Wisconsin Medicare Advantage plans frequently exaggerated members’ health needs. The audits identified nearly $180 million in overpayments across two years.

Audit scope and results

Newly released HHS OIG audits examined HumanaChoice and UnitedHealthcare of Wisconsin. Both plans were found to have engaged in upcoding practices. These actions produced almost $180 million in combined overpayments.

Specific plans audited

The audits targeted HumanaChoice and UnitedHealthcare of Wisconsin. Federal reviewers determined both plans regularly overstated beneficiary health conditions. The resulting overpayments totaled nearly $180 million over the two-year review period.

Overpayment totals

According to Healthcare Dive, the exaggerated diagnoses generated almost $180 million in improper payments. The HHS OIG identified this amount from the two plans combined. Upcoding was the documented mechanism behind the overpayments.

Federal watchdog findings

The federal watchdog accused both Humana and UnitedHealthcare Medicare Advantage plans of upcoding. According to Healthcare Dive, the audits covered HumanaChoice and UnitedHealthcare of Wisconsin. The findings center on health status exaggeration that produced the documented overpayment figure.