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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