Groups representing insurers said an audit from HHS' Office of Inspector General "paints a misleading picture."
In an audit published Oct. 24, the watchdog estimated Medicare Advantage companies received $7.5 billion through health risk assessments and chart reviews.
Around two-thirds of these payments are generated from in-home health risk assessments and chart reviews, the audit found. The OIG wrote these tools may be more "vulnerable to misuse" because they are administered by MA plans or third-party organizations, not enrollees' providers.
In a statement published Oct. 24, Mary Beth Donahue, president and CEO of the Better Medicare Alliance, said the report "paints a misleading picture of in-home health assessments."
The Better Medicare Alliance is backed by major insurers.
"Medicare Advantage is designed to achieve a better overall understanding of individuals' health, and in-home assessments are a crucial part of this model," Ms. Donahue said. "This information ensures seniors get the resources they need. We have supported codified best practices for these assessments and will continue to do so."
In an Oct. 24 statement, AHIP, the trade association representing insurers, said CMS did not concur with key recommendations in the OIG's report.
The agency did not concur with recommendations from the OIG to restrict payments for diagnoses found during in-home visits.
In its statement, AHIP said that health risk assessments are "one of many tools" MA plans use to identify chronic conditions and prevent these conditions from becoming more serious.
"Whether they occur in the patient’s home or in a clinical office setting, the HRA offers an opportunity for the health plan and provider to obtain a complete evaluation of the patient’s physical, behavioral, and mental health needs, medications, health risks, and environmental factors that affect health," the association said.
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