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Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Cigna-HealthSpring Life & Health Insurance Company, Inc. (Contract H4513) Submitted to CMS

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Tuesday, March 28, 2023
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-07-19-01192
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
External entity, if applicable: 
Cigna-HealthSpring Life & Insurance Company, Inc.
Location(s): 
TX,
United States
Type of Report: 
Audit
Questioned Costs: 
$468,372
Funds for Better Use: 
$0
Number of Recommendations: 
3
Report updated under NDAA 5274: 
No
View Document: 
AttachmentSize
PDF icon 71901192.pdf2.41 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
23-A-07-062.01 Open No
We recommend that Cigna-HealthSpring Life & Health Insurance Company, Inc. refund to the Federal Government the $468,372 of overpayments.
23-A-07-062.02 Open No
We recommend that Cigna-HealthSpring Life & Health Insurance Company, Inc. identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before or after our audit period and refund any resulting overpayments to the Federal Government.
23-A-07-062.03 Open No
We recommend that Cigna-HealthSpring Life & Health Insurance Company, Inc. continue its examination of its existing compliance procedures to identify areas where improvements can be made to ensure that diagnosis codes that are at high risk for being miscoded comply with Federal requirements (when submitted to CMS for use in CMS's risk adjustment program) and take the necessary steps to enhance those procedures.
Displaying 3 of 3 Recommendations