In the HHS report of Aetna, the inspector general's office recommended four measures for health insurer to take:

"Refund to the federal government the $632,070 of overpayments;
"Determine for the remaining 159 enrollee-years in the potentially mis-keyed diagnosis code high-risk group not reviewed as part of this audit whether the medical records in each case support the diagnosis for the unrelated condition and refund any resulting overpayments to the federal government;
"Identify, for the high-risk diagnoses included in this report, similar instances of noncompliance that occurred before or after our audit period and refund any resulting overpayments to the federal government; and
"Continue to examine and improve its compliance procedures."

Related: Aetna to face Kraft Heinz lawsuit, alleging health insurer adds 'hidden fees'

Under the Medicare Advantage program, the Centers for Medicare & Medicaid Services makes monthly payments to plans based on a risk-adjustment system that pays more when enrollees are sicker and could require additional health-care resources. However, researchers and regulators have raised red flags about government overpayments to Medicare Advantage plans, arguing associated costs could jeopardize the entire Medicare program. A report by the USC Schaeffer Center for Health Policy and Economics in June found overpayments could reach more than $75 billion this year as a result of favorable selection of healthier beneficiaries, coding intensity and quality bonuses.

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More Medicare Advantage fraud? Aetna received $25.5M in overpayments, says HHS

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