Some Diagnosis Codes That Essence Healthcare, Inc., Submitted to CMS Did Not Comply With Federal Requirements

What OIG allegedly found:

OIG found that some of the diagnosis codes that Essence submitted to CMS for use in CMS’s risk adjustment program did not comply with Federal requirements. For 75 of the 218 enrollee-years, the diagnosis codes (48 acute stroke and 27 major depressive disorder) that Essence submitted to CMS either were not supported in the medical records (70) or could not be supported because Essence could not locate the medical records (5).

https://oig.hhs.gov/oas/reports/region7/71701170.asp