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05/28/26

CMS Potentially Overpaid Medicare Advantage Organizations $462 Million Based on Certain Unsupported Acute Stroke Diagnosis Codes. 

US Office of Inspector General.

Collection Topics
Big Three Conditions Business Case for Excellence Culture, Work System, and Implementation
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Summary

Under Medicare Advantage (MA), CMS links payments to enrollee risk factors, including diagnoses. This audit examines acute stroke diagnosis codes submitted by MA organizations without corresponding hospital records in 2020. The results estimate potential mismatches between physician and hospital coding resulting in $462 million in overpayments to MA providers in 2021.

Read the report
CMS Potentially Overpaid Medicare Advantage Organizations $462 Million Based on Certain Unsupported Acute Stroke Diagnosis Codes. US Office of Inspector General; 2026.