Private Medicare insurers got about $4.2 billion in extra federal payments in 2023 for diagnoses from home visits the companies initiated, even though they led to no treatment, a new inspector general\u2019s report says.<\/p>\n\n\n\n
The extra payments<\/a> were triggered by diagnoses documented based on the visits, including potentially inaccurate ones, for which patients received no other medical services, the report says. Insurers offering private plans under Medicare, known as Medicare Advantage, are paid more when patients have costly conditions.<\/p>\n\n\n\n Each visit was worth $1,869 on average to the insurers, according to the Office of Inspector General for the Department of Health and Human Services. The findings are similar to those of a Wall Street Journal investigation<\/a> published in August. It showed that insurers between 2019 and 2021 pocketed an average of $1,818 for each visit based on diagnoses for which people received no other treatment.<\/p>\n\n\n\n The OIG recommended in Thursday\u2019s report for the first time that Medicare restrict or even cut off payments for diagnoses from these visits. <\/p>\n\n\n\n Read it all<\/a>.<\/p> It is official now that the @HHSOIG<\/a> has determined that #MedicareAdvantage<\/a> health plans w\/ @UHC<\/a> leading the way received over $4B in diagnosis upcoding from home visits. Medicare Paid Insurers Billions for Questionable Home Diagnoses, Watchdog Finds https:\/\/t.co\/OO1R4Alcwk<\/a><\/p>— Ed Gaines (@EdGainesIII) October 24, 2024<\/a><\/blockquote>