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Billions in Estimated Medicare Advantage Payments From Diagnoses Reported Only on Health Risk Assessments Raise Concerns

 Billions in Estimated Medicare Advantage Payments From Diagnoses Reported Only on Health Risk Assessments Raise Concerns

https://oig.hhs.gov/oei/reports/OEI-03-17-00471.asp


OIG analyzed 2016 MA encounter data to determine the 2017 financial impact of diagnoses reported only on HRAs and not on any other records in the encounter data that year.

Most in home HRAs were conducted by companies that partner with or are hired by MAOs to conduct these assessments-and therefore are not likely conducted by the beneficiary's own primary care provider.

Twenty MAOs generated millions in payments from in-home HRAs for beneficiaries for whom there was not a single record of any other service being provided in all of 2016.


Complete 45 page report can be found at:  https://oig.hhs.gov/oei/reports/OEI-03-17-00471.pdf



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