OIG: Tufts Health Plan received $3.7M in overpayments

Tufts Health Plan received $3.7 million in Medicare Advantage overpayments, the HHS Office of Inspector General announced Feb. 14. 

The audit analyzed 212 enrollee-years between 2015 and 2016 involving high-risk diagnostic codes. It found that 154 enrollee-years did not have diagnostic codes supported by medical records, resulting in overpayments. 

The office recommended Tufts Health Plan pay $4 million to correct the overpayments and identify similar instances of noncompliance. 

However, the payer did not agree with the findings or recommendations. It said it had already corrected five enrollee-years in the past, but did not comment on how the remaining 154 enrollee-years were erroneous. 

After reviewing the payer's response and considering the five enrollee-years already corrected, the Office of Inspector General adjusted the initial $4 million figure to $3.7 million.

Subscribe to the following topics: oigaudittufts health planmedicare advantageoverpayment

Copyright © 2025 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


You can unsubscribe from these communications at any time. For more information, please review our Privacy Policy.
 

Articles We Think You'll Like