Medicare Advantage plans received $4.2 billion in payments for questionable home visits, report says. By Aimee Picchi (10/24/24)
Are you a senior wondering why you’ve received so many calls urging you to schedule a home visit with a Medicare medical representative? This article may answer the question, and as usual, it’s about money.
Key quotes:
Medicare Advantage plans reaped $4.2 billion in extra payments last year by making home visits to senior citizens who may not have received treatment for serious health issues, a new government report has found.
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The report flagged UnitedHealth Group, saying it "stood out from its peers, especially in its use of in-home HRAs and HRA-linked chart reviews to generate risk-adjusted payments."
Key points:
Official Report: Report was issued by the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS).
HRAs: Health risk assessments, or HRAs, are home visits that (in UnitedHealthCare’s case) can last 45-60 minutes. HRAs are used to diagnose Medicare enrollees for serious health issues.
Medicare Advantage Plans: Roughly half of the 66 million seniors enrolled in Medicare also are enrolled in a Medicare Advantage (MA) plan, such as those offered by private insurers including UnitedHealthcare and Humana.
Last year, UnitedHealthcare was the top collector with $3.7 billion of risk-adjusted payments, followed by Humana, with $1.7 billion.
No Followup Visits: About 1.7 million Medicare Advantage enrollees received home visits last year but had no follow-up visits, procedures, tests or supplies for their diagnoses. Conclusion: Payments may have been "improper" or enrollees didn't receive needed care.
HRA-Linked Chart Reviews: MA plans also may be receiving additional billions from HRA-linked chart reviews, which occur when a Medicare Advantage company — not the enrollee’s provider — later reviews medical records for diagnoses that a provider didn't submit or may have submitted in error.
$7.5 Billion Combined: Medicare paid private insurers operating Medicare Advantage plans about $7.5 billion last year for diagnoses reported via both HRAs and HRA-linked chart reviews.
$1,869 home visits! Each in-home HRA generates about $1,869 in estimated risk-adjusted payments, whereas Medicare Advantage plans receive only about $365 when patients visit a doctor's office or other health care facility.
Home visits & Chart Reviews, Bogus Diagnoses? Example: MA companies diagnosed an adrenal gland issue called "secondary hyperaldosteronism" in 74% of enrollees through a home visit or HRA-linked chart review that resulted in payment. But, only 3% of enrollees received this diagnosis through a visit to a doctor's office or other health care facility. Hmmm?
