A report released Oct. 24 by the Office of Inspector General found that insurers received an estimated $7.5 billion in Medicare Advantage risk-adjustments for 2023 through health risk assessments and related medical record reviews. OIG said the lack of any other follow-up visits, procedures, tests or supplies for these diagnoses in the MA encounter data raises concerns that either the diagnoses are inaccurate, thus the payments are improper, or MA enrollees did not receive needed care for serious conditions reported only on HRAs or HRA-linked chart reviews. In-home HRAs and HRA-linked chart reviews generated nearly two-thirds of the estimated $7.5 billion, the report said. According to OIG, UnitedHealth Group and Humana accounted for over $5.4B of the estimated $7.5B.

Related News Articles

Headline
The AHA July 3 released the Health Care Plan Accountability Update for the second quarter of 2025. The update covers the latest developments in Medicare…
Headline
The Departments of Justice and Health and Human Services today announced the creation of the DOJ-HHS False Claims Act Working Group to combat health care fraud…
Headline
A report released June 17 by NORC at the University of Chicago, commissioned by the Coalition to Strengthen America’s Healthcare, found that patients enrolled…
Headline
The Centers for Medicare and Medicaid Services May 30 released a notice requesting comments on a proposed Medicare Advantage service level data collection…
Headline
The Government Accountability Office May 29 released a report recommending the Centers for Medicare & Medicaid Services target behavioral health services…
Headline
The Centers for Medicare & Medicaid Services May 21 announced it will immediately begin annual audits of all Medicare Advantage plans and work to clear a…