“A federal watchdog found that Medicare Advantage insurers led by UnitedHealth Group collected billions of dollars in dubious payments from Medicare by using home visits and medical chart reviews to diagnose patients with conditions for which they received no follow-up care,” Casey Ross, Tara Bannow, Lizzy Lawrence, and Bob Herman write over at Stat. “Insurers collectively received an estimated $7.5 billion in payments last year from health risk assessments (HRAs) and related reviews of medical records performed in 2022, a report released Thursday by the Office of Inspector General for the Health and Human Services Department concluded. The diagnoses added during those assessments were not found in any of the patients’ other medical records that year, suggesting that they were either inaccurate or that patients did not get potentially necessary care for serious conditions, the report found. A single company — UnitedHealth Group — accounted for $3.7 billion of the questionable payments, or almost half of the total. The findings mirror an investigation by STAT that found UnitedHealth used its unrivaled network of physicians to pack patients’ charts with diagnoses to reap larger payments from Medicare. UnitedHealth is the country’s largest Medicare Advantage insurer, with about 9.5 million members, roughly 30% of all enrollees. It employs or controls 1 in 10 U.S. physicians — some 90,000 doctors, more than any other major provider or hospital chain. ‘One top MA company, UnitedHealth Group, Inc., stood out from its peers, especially in its use of in-home HRAs and HRA-linked chart reviews to generate risk-adjusted payments,’ the report concluded. It found that UnitedHealth drove two-thirds of the payments based on diagnoses made through those home visits and chart reviews.” Casey Ross, Tara Bannow, Lizzy Lawrence, and Bob Herman, “UnitedHealth collected billions in questionable Medicare payments, federal watchdog finds,” Stat.
