UPMC received $6.4M in overpayments for high-risk diagnoses, inspector general finds

An audit from the HHS Office of Inspector General found that several of UPMC health plan’s high-risk diagnosis codes did not meet federal standards, resulting in $6.4 million in overpayments from 2015 to 2016.

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When looking at 10 high-risk groups, the office found 194 of 280 reviewed UPMC enrollee years did not meet federal standards, according to a Nov. 5 news release from the office.

UPMC did not agree with the initial audit, resulting in a revised, final version that brought the draft figure from $6.6 million in overpayments to $6.4 million, according to the report. 

The office recommended UPMC refund the overpayments and review its compliance.

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