Healthcare Finance News September 23, 2021
OIG suspected MA companies have financial incentives to make beneficiaries appear as sick as possible.
A new report examining Medicare Advantage plans released by the Department of Health and Human Services’ Office of the Inspector General found that some MA plans are leveraging chart reviews and health risk assessments to drive up to $9.2 billion in payments.
The Centers for Medicare and Medicaid Services risk-adjusts payments by using beneficiaries’ diagnoses to pay higher capitated payments to companies with contracts under Medicare Advantage for those expected to have higher-than-average medical costs.
OIG said it suspected this may create financial incentives for MA companies to make beneficiaries appear as sick as possible. For CMS to risk-adjust payments, MA companies report beneficiaries’...
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