According to the report, 45 out of 100 PacifiCare Medicare Advantage cases analyzed from 2007 billed the federal insurance program for treatment patients with serious conditions like cancer that conflicted with medical records. Medicare pays a higher rate to patients with more serious conditions.
HHS ordered UnitedHealth, which owns PacifiCare, to pay back the $224,388 it received from the 45 faulty billing codes. If the sample rate of overbilling was true for the 188,000 PacifiCare patients that year, the OIG estimated the overpayments would have totaled $424 million, although UnitedHealth claimed the sample size is too small to be applied to so many patients.
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