Medicare Advantage plans have come under scrutiny for reaping $4.2 billion in extra payments last year through home visits to senior citizens to diagnose serious health issues, as revealed in a new government report by the Office of Inspector General for the Department of Health and Human Services. These home visits, known as health risk assessments (HRAs), are used to trigger higher risk-adjusted payments for Medicare Advantage plans based on seniors’ health conditions. The report raises concerns about the misuse of HRAs and the amount of taxpayer spending associated with these visits, especially when they don’t lead to necessary care.
Leading insurers like UnitedHealthcare and Humana benefitted from these practices, with UnitedHealthcare receiving $3.7 billion and Humana receiving $1.7 billion in risk-adjusted payments. The report indicated that 1.7 million Medicare Advantage enrollees received home visits last year without follow-up care, raising questions about the validity of the payments.
Overall, the Medicare Advantage system paid private insurers approximately $7.5 billion last year due to diagnoses reported through HRAs and related chart reviews. Concerns have been raised about potential misuse of these practices, especially when diagnoses aren’t backed up by visits to healthcare providers.
Aimee Picchi
Aimee Picchi is the associate managing editor for CBS MoneyWatch, where she covers business and personal finance. She previously worked at Bloomberg News and has written for national news outlets including USA Today and Consumer Reports.