Lexology January 7, 2020
Riker Danzig Scherer Hyland & Perretti LLP

HHS OIG Finds That Medicare Advantage Payments From Chart Reviews Raise Concerns

HHS’s Office of Inspector General has raised concerns about the use of Medicare Advantage Organizations (MAOs) use of medical chart reviews to obtain higher payments. By analyzing the 2016 Medicare Advantage data, the OIG found that: (1) MAOs almost always used chart reviews as a tool to add, rather than to delete diagnoses; (2) diagnoses that MAOs reported only on chart reviews- and not any service records- resulted in an estimated $6.7 billion in risk-adjusted payment in 2017; (3) CMS based an estimated $2.7 billion in risk-adjusted payments that MAOs did not link to a specific service provided to a beneficiary – much less a face-to-face visit with...

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Topics: CMS, Govt Agencies, Health System / Hospital, Insurance, Medicare Advantage, Payer, Physician, Primary care, Provider
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