July 13, 2015

Audit: Lovelace Health Plan overbilled Medicare Advantage

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An audit that included a healthcare plan in New Mexico found overbilling of a Medicare program. The healthcare plan in question is from Lovelace Health Plan.

Health MoneyThe audit showed that the overbilling occurred through Medicare Advantage Plans, which use a risk score to determine how much to bill.

The Center for Public Integrity originally requested the audit findings under the Freedom of Information Act, but didn’t receive anything until the organization filed a lawsuit to see the records.

Fred Schulte, the reporter who has been at the forefront of the battle to obtain the records, spoke with New Mexico Political Report over the phone about the audit and what he finally received.

Schulte said Lovelace Health Plan was about on par with the other groups when it came to billing mistakes.

“Overall there wasn’t a whole lot of difference,” Schulte said in reference to how bad the mistakes were.

When New Mexico Political Report reached out to Lovelace, a spokeswoman said the group was sold to Blue Cross Blue Shield, and there was no one at Lovelace that could speak about the audit. Blue Cross Blue Shield, through a spokeswoman said Lovelace was only recently obtained so they were not familiar with the audit or the findings.

Schulte said he had the same experience when he tried to get more information.

“It was kind of like the scarecrow in the Wizard of Oz, everybody was pointing fingers in different directions,” Schulte said.

He said Lovelace and Blue Cross Blue Shield were not alone.

“To be fair, nobody else was answering questions about this either,” Schulte said.

Schulte was also quick to point out that the audit didn’t show any evidence of intentional wrongdoing, but it did show medical coding errors. He added that the process of coding can be “pretty complex.”

Schulte and his colleagues began looking into the national trend of medical overbilling after they discovered a similar case in Florida.

“We went in with the Wall Street Journal and began to do a whole series on upcoding,” he said.

The audit, Schulte said, is just that and added that “it’s not a criminal proceeding.”

Last month though, a Kentucky doctor was charged federally for upcoding, or fraudulently reporting medical visits, among other charges related to fraud and illegally dispensing prescription drugs.

*Correction: A previous version of this story contained a misspelling of Fred Schulte’s name. We regret the error.