Health Plan Weekly

OIG: CMS Paid MA Insurers Billions for Questionable Use of In-Home Assessments

  • Oct 25

    Oct 25, 2024

    Medicare Advantage insurers received an estimated $4.2 billion in risk-adjusted reimbursement in 2023 for diagnoses gleaned from home visits designed to assess members’ care needs, according to a new report by the HHS Office of Inspector General. These assessments were often administered by third-party vendors hired by the insurers and led to no treatment, according to OIG. While MA plans are allowed to use chart reviews and HRAs as sources of diagnoses for risk adjustment purposes, the Oct. 21 report builds on OIG’s documented concerns regarding misuse of health risk assessments and HRA-related chart reviews for the purposes of risk adjustment. Read more
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    • Jinghong Chen

    Jinghong has been producing infographics and data stories on employer-sponsored insurance, public health insurance programs and prescription drug coverage for AIS Health’s Health Plan Weekly and Radar on Drug Benefits since 2018. She also manages AIS Health’s annual executive compensation database for top insurers and Blue Cross and Blue Shield affiliates. Before joining AIS Health, she interned at WBEZ, Al Jazeera English and The New York Times Chinese. She graduated from Missouri School of Journalism with a focus on data journalism and international reporting.

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Managing Editor, Radar on Specialty Pharmacy and Spotlight on Market Access

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