Fierce Healthcare September 23, 2021
Paige Minemyer

Medicare Advantage plans are using chart reviews and health risk assessments to drive higher payments, to the tune of $9.2 billion, according to a new report from the Department of Health and Human Services’ Office of Inspector General (OIG).

OIG analyzed MA encounter data from 2016 to determine whether plans were using chart reviews and HRAs to increase their risk-adjustment payments disproportionately relative to their size or their peers.

Chart reviews can identify diagnoses that were submitted in error, and HRAs can be used to gather additional information about beneficiaries to identify gaps in care.

According to the OIG report, 20 of the 162 MA insurers included in the study drove the bulk of the $9.2 billion in overpayments. Each...

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Topics: Govt Agencies, Insurance, Medicare Advantage, OIG, Payer, Provider, Survey / Study, Trends
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