A 2023 report by the Office of Inspector General (OIG) has revealed that private insurers under Medicare Advantage received an extra $4.2 billion based on home visit diagnoses that often led to no further medical treatment.
Key Findings
- Medicare Advantage plans boosted payments using home diagnoses without requiring additional medical intervention.
- Many of these health risk assessments were used solely for financial gain rather than patient care.
- The OIG recommends that Medicare eliminate or limit payments based on home health visits.
- Medicare disputes the findings, citing study limitations and the potential benefits of home diagnoses.
The report has raised concerns about how insurers use diagnoses for financial gain, sparking calls for stricter oversight and policy changes to ensure accurate billing practices.
For more details, visit The Wall Street Journal.
