From the public record · not a Soft Home Global client
Acute diagnoses that should have been "history of": what OIG found at MediGold
When the condition is no longer being actively treated. OIG found that for 189 of 210 sampled enrollee-years, the medical records MediGold provided did not support the high-risk diagnosis codes it submitted — typically an acute stroke, heart attack, embolism or cancer diagnosis appearing once, with no hospital claim or treatment behind it, where a "history of" code should have been used.
This is a summary of a published audit by the HHS Office of Inspector General. MediGold (Medicare Advantage contract H3668) is not a client of Soft Home Global, and Soft Home Global had no part in the audit. Every figure is quoted from the report, which is linked below — read it rather than rely on this page. Where MediGold (Medicare Advantage contract H3668) disputed a finding, that is shown too: these are audit findings, not a court’s verdict.
The audit
What went wrong, claim type by claim type
Acute stroke
One of seven high-risk groups
A single acute stroke diagnosis on one physician claim with no corresponding inpatient or outpatient hospital claim for stroke.
Why, per the report: OIG: a history-of-stroke diagnosis, which does not map to a risk-adjustment HCC, typically should have been used.
Acute myocardial infarction
One of seven high-risk groups
A single acute heart attack diagnosis with no corresponding inpatient hospital claim within 60 days either side.
Why, per the report: OIG: a history-of-myocardial-infarction diagnosis typically should have been used.
Embolism
One of seven high-risk groups
A single embolism diagnosis with no anticoagulant medication dispensed.
Why, per the report: OIG: a history-of-embolism diagnosis typically should have been used.
Lung and breast cancer
Two of seven high-risk groups
A single cancer diagnosis with no surgery, radiation or chemotherapy within six months before or after.
Why, per the report: OIG: a history-of-cancer diagnosis typically should have been used.
How it was to be resolved
OIG recommended that MediGold:
- Refund $2,183,514 in estimated net overpayments
- Identify similar noncompliance before and after the audit period for these high-risk diagnoses and refund any overpayments
- Continue examining its compliance procedures to find improvements that ensure diagnosis codes at high risk of being miscoded comply with Federal requirements, and enhance those procedures
What MediGold said: MediGold disagreed with some findings and all recommendations and asked OIG to withdraw them. It disputed 30 of the 194 enrollee-years identified in the draft report; the final report found 189 unsupported.
What a practice or billing team can take from it
These points are Soft Home Global’s reading of the report, not OIG’s words.
- An acute diagnosis carried onto a later visit is precisely the pattern OIG built these high-risk groups to find. If the patient is not being treated for the condition now, the code is usually a history-of code.
- A diagnosis that appears once, with no hospital claim, medication or treatment behind it, is exactly what an auditor pulls first.
- Coding what the clinician wrote is not the same as coding what the record supports. The query is the fix.
Questions
When should a "history of" diagnosis code be used instead of an acute one?
When the condition is no longer being actively treated. OIG found that for 189 of 210 sampled enrollee-years, the medical records MediGold provided did not support the high-risk diagnosis codes it submitted — typically an acute stroke, heart attack, embolism or cancer diagnosis appearing once, with no hospital claim or treatment behind it, where a "history of" code should have been used.
Is MediGold (Medicare Advantage contract H3668) a Soft Home Global client?
No. This page summarises a public audit report published by the HHS Office of Inspector General (report A-07-20-01198, issued February 2024). Soft Home Global had no involvement with MediGold (Medicare Advantage contract H3668) or with the audit.
Did MediGold (Medicare Advantage contract H3668) agree with the findings?
MediGold disagreed with some findings and all recommendations and asked OIG to withdraw them. It disputed 30 of the 194 enrollee-years identified in the draft report; the final report found 189 unsupported.
Source
Figures read from the report on 15 September 2026.
Next step
Would your claims pass the same review?
Send a ninety-day denial report and an aged AR summary, with no patient identifiers. Within two working days you get a written summary of which denial reasons are costing you most and what is recoverable.
Or write to ops@softhomeglobal.com