Inspector General finds overpayments to Medicare Advantage companies

The Department of Health and Human Services’ Office of Inspector General found that taxpayers fund billions of dollars in overpayments to Medicare Advantage companies each year based on unsupported diagnoses for enrollees. Twenty Medicare Advantage companies each had a share of payments from health risk assessments and HRA-linked chart reviews that exceeded their percentage of enrollees by more than 25%, the agency said in a report. Taken together, these 20 companies generated 80%, or $6B of $7.5B, of the estimated 2023 risk-adjusted payments from HRAs and HRA-linked chart reviews while covering only half of Medicare Advantage enrollees. One top Medicare Advantage company, UnitedHealth Group (UNH), “stood out from its peers, especially in its use of in-home HRAs and HRA-linked chart reviews to generate risk-adjusted payments,” according to the Office of Inspector General. Ohers involved include Alignment Healthcare (ALHC), Humana (HUM) and Cigna (CI), according to the agency.