Medicare Advantage In-Home Health Assessments Continue To Raise Questions

Home Health Care News October 28, 2024
Audrie Martin

Medicare Advantage (MA) companies receive higher risk-adjusted payments from the Centers for Medicare & Medicaid Services (CMS) for sicker enrollees. This helps ensure that plans receive sufficient payments to cover increased care costs and that enrollees have access to plans. However, a new report states that taxpayers are footing the bill for billions of dollars in overpayments to these companies every year based on unsupported diagnoses for MA patients.

In the report, the Department of Health and Human Services Office of Inspector General (OIG) identified two sources of enrollee diagnoses – health risk assessments (HRAs) and chart reviews – as vulnerable to misuse by MA companies.

This new evaluation updated the OIG’s previous findings, which determined whether vulnerabilities persist regarding...

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