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Medicare Advantage Compliance Audit of Diagnosis Codes That Inter Valley Health Plan, Inc. (Contract H0545), Submitted to CMS

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Monday, September 26, 2022
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-05-18-00020
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
External entity, if applicable: 
Inter Valley Health Plan
Location(s): 
CA,
United States
Type of Report: 
Audit
Questioned Costs: 
$5,372,998
Funds for Better Use: 
$0
Number of Recommendations: 
2
View Document: 
AttachmentSize
PDF icon 51800020.pdf1.61 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
22-A-05-108.01 Open No
We recommend that Inter Valley Health Plan, Inc. refund to the Federal Government the $5,372,998 of estimated net overpayments.
22-A-05-108.02 Open No
We recommend that Inter Valley Health Plan, Inc. continue to enhance 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