Medicare Advantage plans made $7.5B from ‘questionable’ assessments in 2023: OIG

Becker's Healthcare October 24, 2024
Rylee Wilson

Medicare Advantage companies are bringing in billions in “questionable” payments found during in-home visits and chart-reviews, HHS’ Office of Inspector General claimed in a new audit.

In a report published Oct. 24, the federal watchdog estimated Medicare Advantage companies received $7.5 billion in payments through health risk assessments and chart reviews.

The watchdog wrote that “questionable use” of HRAs is driving up payments to plans.

Medicare Advantage plans conduct HRAs to collect information about enrollee health status. These assessments are sometimes conducted by providers as part of beneficiaries’ annual wellness visits, or in enrollees homes. MA plans also conduct chart reviews to find diagnoses that may have been missed by providers during visits.

CMS found 1.7...

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