Greater Scrutiny of Payments to Private Medicare Insurers Urged

Sept. 22, 2021, 6:05 PM

A government watchdog agency is calling for greater oversight of 20 private Medicare Advantage plans that received a disproportionate share of $9.2 billion in enhanced payments in 2016 that were based on potentially suspect patient diagnoses.

The Health and Human Services Office of Inspector General’s report released Wednesday said the enhanced “risk-adjusted” payments were generated through both “chart reviews” of patient records to “identify diagnoses that a provider did not submit or submitted in error,” and through “health risk assessments,” in which someone who’s usually uninvolved in the patient’s care visited their home and evaluated their medical conditions.

The report ...

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