The OIG Did It Again: What the Latest Medicare Advantage Audit Signals
- Martha Goodlin
- 4 days ago
- 2 min read
The Office of Inspector General (OIG) has released another targeted Medicare Advantage (MA) compliance audit, this time focused on Humana Health Benefit Plan of Louisiana (Contract H1951).Read the full OIG report → https://oig.hhs.gov/reports/all/2025/medicare-advantage-compliance-audit-of-specific-diagnosis-codes-humana-health-benefit-of-louisiana-contract-h1951-submitted-to-cms/
This marks only the second targeted MA audit issued so far in 2025, yet the findings closely mirror patterns seen across prior reviews—reinforcing that these issues are neither new nor isolated.
Familiar Findings, Consistent Patterns
Many of the high-risk diagnosis codes reviewed were not fully supported by the medical record. Variation by condition remains notable, underscoring that documentation risk is condition-specific, not uniform.
Financial Impact and Regulatory Context
The OIG estimated approximately $10.5 million in net overpayments, though regulatory recovery limits reduced the recommended repayment to roughly $5.5 million. This gap highlights an important reality for MA organizations: audit exposure is influenced not only by clinical findings, but also by evolving regulatory frameworks that shape enforcement and recovery.
The Broader Signal to Plans
The OIG emphasized that its High-Risk Diagnosis Code Toolkit is a reference point—not a checklist—and that audit selection is driven by data, clinical judgment, and plan-specific risk patterns.
Plans that move beyond generic coding guidance and adopt more deliberate, condition-aware compliance strategies will be better positioned as audit scrutiny continues to intensify.
How Rebellis Can Help
Rebellis supports Medicare Advantage organizations in strengthening audit readiness by aligning regulatory insight, clinical realities, and operational execution—before issues surface in an audit. Our focus is on helping plans move from reactive response to proactive confidence.
The OIG’s message remains consistent: plans that act early and intentionally fare far better than those reacting audit by audit.
Contact us to learn how Rebellis helps organizations prepare for what comes next.
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