Humana Inc., United Health Group Inc. and other insurers operating Medicare Plan managed-care plans may have to reimburse the government as much as $370 million next year if audits find the companies were overpaid.
Nearly 11 percent of government payments to the health plans were flawed in 2011, according to the U.S. Centers for Medicare and Medicaid Services. Government audits of 30 unmentioned plans will study whether clinical records rationalize payments made for medical services, according to the agency. About 25 percent of the 45 million Americans enrolled in Medicare Insurance are part of private Medicare Advantage plans, which are paid a fixed fee to provide the program’s traditional insurance benefits along with additional such as gym memberships and eyeglasses.
United Health, based in Minnetonka, Minnesota, had the majority Medicare Advantage customers in the fourth quarter, with 2.2 million, followed by Louisville, Kentucky-based Humana, with 1.9 million, according to data collected by Bloomberg.
The government estimates it may have overpaid the industry as much as $12.4 billion last year. The 11 percent error rate for private plans compares to with an 8.6 percent rate in traditional Medicare, the government said.
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