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Courtesy of Humana
Humana allegedly overcharged the federal government by nearly $200 million for submitting documentation that inaccurately showed some of its Medicare Advantage members were sicker than they actually were in 2015, according to an audit conducted by the HHS Office of Inspector General.
OIG is recommending Humana return $197.7 million and improve its policies to prevent such overpayments in the future. The watchdog said the errors occurred because Humana s policies to catch and prevent such overcharges were not always effective, according to the audit released Monday.
The federal government pays MA organizations monthly in order for them to deliver coverage to seniors. The sicker the member, the more money an MA plan stands to receive from CMS. Audits are conducted to make sure health plans are not upcoding diagnosis codes, or making members appear sicker than they actually are in order to receive additional funds
Director, Fiscal Program Coordination and Special Projects, April Ferrino
April Ferrino is the director of Fiscal Program Coordination and Special Projects in the Chief Financial Officer division of the Texas Health and Human Services Commission. She is responsible for the development and oversight of Medicaid supplemental and directed payment programs.
Ferrino has more than 20 years of Texas government experience. Before joining HHSC, she was an analyst at the Legislative Budget Board, managing multiple research projects that resulted in the implementation of budget and policy recommendations. She has also worked for the HHS Office of Inspector General.
Additionally, Ferrino studied social welfare systems in Europe and Croatia and was one of three Americans chosen in 2013 for the prestigious Ian Axford Fellowships in Public Policy in New Zealand. While in New Zealand, she conducted a nine-month independent research project that identified recommendations to the Ministry of Health
Ashlee Rezin Garcia / Sun-Times
A senior political appointee in the Trump administration stifled attempts by Chicago-based environmental regulators to investigate and remedy cancer-causing ethylene oxide releases in the Chicago area, a new government report says.
The unnamed official instructed the Chicago office of the federal Environmental Protection Agency to refrain from inspecting ethylene oxide facilities including the Sterigenics medical sterilization plant in Willowbrook unless asked to by state officials, according to the report from the EPA’s inspector general.
Citing information investigators gathered from managers from the EPA’s Chicago region office, the report says “senior leaders” instructed staff members of the agency to limit air monitoring around the Sterigenics plant, refrain from seeking health and risk assessments from federal health officials and hold off on sending requests for information to ethylene oxide facilities in the area.