Medicare officials are pushing back against a federal watchdog\u2019s call to crack down on home visits by Medicare Advantage health plans \u2014 a practice the watchdog says may waste billions of tax dollars every year.<\/p>\n
In\u00a0late October<\/a>, a\u00a0Health and Human Services inspector general<\/strong>\u00a0audit found that the insurers pocketed\u00a0$7.5 billion<\/strong>\u00a0in 2023 from diagnosing health conditions that prompted no medical services \u2014 about\u00a0$4.2 billion<\/strong>\u00a0of it through the health assessments done in patients\u2019 homes.<\/p>\n Assistant Inspector General\u00a0Erin Bliss<\/strong>\u00a0told 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.<\/p>\n But the power to curb billing tied to home visits rests with regulators at the\u00a0Centers for Medicare and Medicaid Services<\/strong>, who appear unmoved by the OIG\u2019s criticism.<\/p>\n In a statement to KFF Health News by spokesperson\u00a0Alexx Pons<\/strong>, CMS said it \u201cappreciates the OIG\u2019s review in this area\u201d and will keep studying the issue.<\/p>\n In a formal response published in the audit report, CMS said it disagreed with the watchdog\u2019s call to restrict use of home health assessments in computing how much to pay health plans. People on Medicare \u201cshould have access to care that is appropriately provided in the home setting,\u201d CMS wrote.<\/p>\n That\u2019s just fine with the insurance industry. The OIG drew \u201cinaccurate conclusions,\u201d said\u00a0Heather Soule<\/strong>, a spokesperson for\u00a0UnitedHealthcare<\/strong>. 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.<\/p>\n The home visits are \u201camong the most comprehensive and thorough assessments of a patient\u2019s 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,\u201d Soule said in the statement.<\/p>\n Medicare Advantage plans serve more than\u00a033 million<\/strong>\u00a0Americans, more than half of the people eligible for Medicare.<\/p>\n Government spending on the program, which is dominated by a handful of private health insurance companies, is expected to hit\u00a0$462 billion<\/a> this year. The industry\u00a0argues that<\/a>\u00a0most Medicare Advantage enrollees are satisfied with the care they receive and typically pay less out-of-pocket than those enrolled in original Medicare.<\/p>\n But critics of the program point to years and years of federal audits<\/a>, whistleblower lawsuits and other investigations revealing that many health plans exaggerate how sick patients are to boost their payments.<\/p>\n This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org<\/a>.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n