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OIG Concerned Over Billions in Estimated MA Payments From Chart Reviews
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CMS Rules

OIG Concerned Over Billions in Estimated MA Payments From Chart Reviews

December 18th, 2019 Veronica Graff CMS Rules, National News, News

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.

Check out Modern Healthcare and Managed Care Mag for more on the report.

 

  • Tags
  • Centers for Medicare and Medicaid Services
  • chart reviews
  • Department of Health and Human Services
  • HHS
  • MAOs
  • Medicare Advantage organizations
  • Office of Inspector General
  • OIG
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Veronica Graff

Business journalist and recent graduate from the Walter Cronkite School of Journalism and Mass Communication with minors in business and philosophy. Emphasis in financial, economic and market reporting. Regular contributor to The Hertel Report.

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