Watchdog Flags $7.5 Billion Paid to Private Medicare Plans (1)

A government watchdog office is calling for greater oversight of private Medicare Advantage plans that received the majority of $7.5 billion in enhanced payments in 2023 that were based on potentially suspect patient diagnoses.

Most of these risk-adjusted payments were generated through in-home “health risk assessments” and HRA-linked chart reviews, according to the report by the HHS Office of Inspector General. These health risk assessments typically involve someone, who’s usually uninvolved in the patients’ care, visiting the beneficiaries’ homes and evaluating their medical conditions.

About half of Medicare beneficiaries get their coverage through Medicare Advantage plans, in which private insurance ...