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CA health plan may have overbilled Medicare $424M

California Watch, December 18, 2012
Medicare may have overpaid an estimated $424 million to PacifiCare of California's Medicare Advantage plan based on risk assessments that in many cases made patients seem sicker than they were, according to a federal oversight agency. Medicare Advantage plans send patient diagnosis codes to Medicare, which boosts plan rates if clients are affected by serious medical conditions. A new report by the U.S. Health and Human Services inspector general says PacifiCare was paid extra for treating patients with cancer or a dangerous bloodstream infection even though medical records didn't describe those ailments.