2 days Ago By Fred Schulte, KFF Health News
Medicare officials are pushing back against a federal watchdog’s call to crack down on home visits by Medicare Advantage health plans — a practice the watchdog says may waste billions of tax dollars every year. Health Brief is a coproduction of The Washington Post and KFF Health News. In , a audit found that the insurers pocketed in 2023 from diagnosing health conditions that prompted no medical services — about of it through the health assessments done in patients’ homes.
Assistant Inspector General told me the plans are raking in billions of dollars without providing any treatment for medical conditions the plans flagged during the visits, including serious diseases such as diabetes and major depression. But the power to curb billing tied to home visits rests with regulators at the , who appear unmoved by the OIG’s criticism. In a statement to KFF Health News by spokesperson , CMS said it “appreciates the OIG’s review in this area” and will keep studying the issue.
In a formal response published in the audit report, CMS said it disagreed with the watchdog’s call to restrict use of home health assessments in computing how much to pay health plans. People on Medicare “should have access to care that is appropriately provided in the home setting,” CMS wrote. That’s just fine with the insurance industry.
The OIG drew “inaccurate conclusions,” said , a spokesperson for . The insurer is the largest Medicare Advantage contractor and accounted for about two-thirds of the payments tied to home visits and related data mining of patient files cited in the audit. The home visits are “among the most comprehensive and thorough assessments of a patient’s health and physical environment available in the health-care system, helping to identify and drive needed follow-on care for the vast majority of the patients with whom we engage,” Soule said in the statement.
Medicare Advantage plans serve more than Americans, more than half of the people eligible for Medicare. Government spending on the program, which is dominated by a handful of private health insurance companies, is expected to hit this year. The industry most Medicare Advantage enrollees are satisfied with the care they receive and typically pay less out-of-pocket than those enrolled in original Medicare.
But critics of the program point to years and years of , whistleblower lawsuits and other investigations revealing that many health plans exaggerate how sick patients are to boost their payments. ,.
