UnitedHealth Unit Got $115M In CMS Overpayments, Audit Says

Law360, New York (June 7, 2012, 1:52 PM EDT) -- UnitedHealth Group unit PacifiCare Health Systems Inc. received over $115 million in Medicare Advantage overpayments from the Centers for Medicare & Medicaid Services in 2007 by submitting faulty patient diagnoses used by the agency to calculate reimbursements, according to a report released Tuesday.

In a random sampling of 100 Medicare Advantage beneficiaries submitted by PacifiCare to CMS in 2007, nearly half of the claims contained invalid diagnoses used to calculate a patient's risk score, which CMS uses to calculate payments, according to an audit released by...
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