A report from the Department of Health and Human Services (HHS) inspector general’s office analyzed Medicare Advantage (MA) encounter data from 2016, stemming from concerns that MA organizations use chart reviews to inaccurately inflate risk adjusted payments. The result was billions in additional payments.
The Office of Inspector General (OIG) found that for the most part, MA organizations used chart reviews to add diagnoses rather than eliminating them. The reported diagnoses were based on chart reviews rather than service records or a face-to-face visit. The additional payments resulted in $6.7 billion in risk-adjusted payments for 2017.
Access the full report on the OIG site.
For a summary of the report, click here.