U.S. agency says Bravo Health altered documents for audit

Posted: September 21, 2013

Bravo Health Pennsylvania, which serves Philadelphia-area patients through Medicare Advantage insurance plans, altered documents submitted to the federal government during an audit of the company's billing practices, according to a report by the Office of Inspector General of the Department of Health and Human Services.

Bravo agreed July 26 to pay $225,000 to settle allegations that it violated laws related to altered records.

"We discovered that some of the medical records that Bravo submitted to us during our fieldwork had been altered and resubmitted," says the OIG report, which looked at billing from 2007.

The Inquirer obtained a copy of the full audit report that is scheduled to be released Friday, and it suggests that Bravo might owe taxpayers as much as $26 million because of other unsubstantiated bills.

Bravo, whose parent company was based in Baltimore, was bought twice during the period of the audit and preparation of the report. Nashville-based HealthSpring Inc. bought Bravo for $575 million in 2010, and Connecticut-based Cigna then bought HealthSpring in 2012 for $3.8 billion.

"Bravo said there was no intent to deceive OIG and the federal government," Cigna spokeswoman Graham Harrison said. However, she said, the company disagrees with most of the rest of the audit and any suggestion it owes more money.

Medicare is the federal government insurance program serving mostly people age 65 and older, but it has several parts.

Medicare Part C is also called Medicare Advantage. These health insurance plans are through private companies, often covering all of a patient's health care. The government bases payments to insurers in part on the diagnosis of the patient by a doctor or other health-care provider. Doctors and insurers are supposed to record the diagnosis and its corresponding code, and retain documentation.

Bravo had several contracts with Medicare in 2007. The audit looked at one of them, which paid Bravo approximately $194 million to administer health-care plans for about 13,755 people.

In 65 of 100 sample cases, the audit found, the diagnoses supplied did not have proper documentation to support them, did not have any documentation, or did not include the doctors' signatures or credentials.

The OIG audit says Bravo "should" refund $442,409 in overpayments in the sample and work with Medicare officials to determine the "correct contract-level adjustment for the projected $22,108,905 of overpayments."

OIG noted that its estimates of the overpayments ranged from $17.4 million to $26.9 million.

Cigna's Harrison, however, said Medicare has indicated it won't seek payments that far back.

Contact David Sell at 215-854-4506, dsell@phillynews.com, or @phillypharma. Read his blog at www.inquirer.com/phillypharma.

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