Private Medicare insurers received about $4.2 billion extra in federal payments in 2023 for diagnoses from home visits that they initiated, even when there was no follow-up treatment, according to a new inspector general report.
The report says these extra payments were based on diagnoses from these visits, some of which may have been inaccurate, where patients didn’t receive any other medical care. Insurers offering Medicare Advantage plans get higher payments when patients are diagnosed with costly conditions.
The average value of each visit was $1,869 for the insurers, according to the Office of Inspector General for the Department of Health and Human Services. This report echoes a Wall Street Journal investigation from August, which found that between 2019 and 2021, insurers earned an average of $1,818 for visits based on diagnoses that led to no further treatment.
For the first time, the OIG has recommended that Medicare limit or even stop payments for diagnoses from these home visits. However, the Medicare agency disagreed with this recommendation, pointing out the study’s limitations. They said they are committed to ensuring that diagnoses, including those from home visits, are accurate.
Medicare Advantage was designed to cut costs and improve care for seniors and disabled people, but researchers and the Medicare Payment Advisory Commission (MedPAC), a nonpartisan watchdog, have found that it’s ended up costing more than traditional Medicare. This is partly because insurers have found ways to maximize payments through the pay-for-diagnoses model.
Private Medicare insurers got about $4.2 billion in extra federal payments in 2023 for diagnoses from home visits the companies initiated
These insurers did rake in extra money from wellness visits, but it wasn’t necessarily from ‘diagnoses.’ Is that how certain news outlets are spinning this?
@Blayne
Probably from the Wall Street Journal. It’s owned by the same group.
It’s interesting how Medicare Advantage is criticized for both overspending due to excessive care and also for not providing enough care. Seems like they can’t win.
@Larkin
Actually, both criticisms could be true. If the home visits are identifying conditions that lead to more payments, but then those conditions aren’t actually treated, it’s a problem on both fronts.