Christopher G. Bresette, CPA

Assistant Regional Inspector for Audit Services · Office of Inspector General (OIG) · company speakers →

Our day 2 general session will be a presentation by Christopher G. Bresette, CPA, Assistant Regional Inspector General for Audit Services, Office of Inspector General. Bresette was involved with a recent audit of particular interest to attendees of the ACDIS Symposium: Outpatient CDI. The report is entitled “Some diagnosis codes that Essence Healthcare, Inc., submitted to CMS did not comply with federal requirements.” You can find it here. In this audit the OIG reviewed a Medicare Advantage organization, Essence Healthcare, Inc. (Essence), and focused on two areas that included high-risk diagnosis codes. Its objective was to determine whether selected diagnosis codes that Essence submitted to CMS for use in CMS’s risk adjustment program complied with Federal requirements. The OIG selected 218 unique enrollee-years with high-risk diagnosis codes during calendar years 2012 through 2014. The 218 enrollee-years included 52 diagnoses of acute stroke and 166 diagnoses of major depressive disorder. It determined that Essence received $158,904 of overpayments.

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