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Medicare Advantage Compliance Audit of Diagnosis Codes That Health Net of California, Inc. (Contract H0562) Submitted to CMS

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Friday, September 22, 2023
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-09-18-03007
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
External entity, if applicable: 
Health Net of California, Inc.
Location(s): 
CA,
United States
Type of Report: 
Audit
Questioned Costs: 
$69,182
Funds for Better Use: 
$0
Number of Recommendations: 
1
Report updated under NDAA 5274: 
No
View Document: 
AttachmentSize
PDF icon 91803007.pdf6.49 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
23-A-09-121.01 Open No
We recommend that Health Net of California, Inc. refund to the Federal Government the $69,182 of net overpayments.
23-A-09-121.02 Open No
We recommend that Health Net of California, Inc. continue to improve its policies and procedures to prevent, detect, and correct noncompliance with Federal requirements for diagnosis codes that are used to calculate risk-adjusted payments.
Displaying 2 of 2 Recommendations