In case you missed it, The Wall Street Journal details a new report from the Office of Inspector General (OIG) revealing how corporate Medicare Advantage insurers captured $4.2 billion last year in extra payments from home visits they initiated that led to no additional treatment. This report offers yet another example of certain corporate insurers upcharging the federal government to increase their profits at the expense of American taxpayers while providing less care to patients.
Medicare Advantage pays corporate insurers more when patients have costly conditions, so insurers are incentivized to diagnose more of them. Certain corporate insurance companies have used home visits as an opportunity to make more patient diagnoses to boost their bottom line.
In 2023, each Medicare Advantage home visit was worth $1,869 on average. The Wall Street Journal reports that $4.2 billion in payments made to Medicare Advantage insurers “were triggered by diagnoses documented based on the visits, including potentially inaccurate ones, for which patients received no other medical services.” Some corporate insurers are abusing the system to “draw ever-greater payments from the pay-for-diagnoses system” without providing more care.
As Erin Bliss, assistant inspector general for evaluation and inspections, told The Wall Street Journal: “We’re seeing that some Medicare Advantage companies are making billions from the health risk assessment diagnoses without providing care for the conditions that they identify.” She notes that this could either mean that certain diagnoses are false, or that corporate insurers are failing to connect patients with necessary care while still profiting from their conditions. Bliss says, “Profiting off enrollees’ medical conditions without providing treatment for those conditions is wrong.”
Some corporate Medicare Advantage companies have come under fire this year for the numerous harmful ways in which they exploit seniors and the Medicare Advantage program to increase profits without providing increased access to care:
- A Wall Street Journal investigation found that corporate Medicare Advantage insurers pocketed an extra $15 billion for questionable home visit diagnoses from 2019 to 2021.
- STAT News revealed that the largest Medicare Advantage insurer used “a thinly tested medical device” to “dramatically boost [] payments from the federal government for years even though many of the patients were not sick.”
- A MedPAC report found that Medicare Advantage has cost taxpayers $591 billion more over the past 18 years compared to traditional Medicare, which is not administered by corporate insurance companies.
The Medicare Advantage program was intended to save the federal government money, but thanks to the greed of some corporate insurers, it has done the opposite. Medicare Advantage is projected to cost taxpayers $88 billion more per year in 2024 than traditional fee-for-service Medicare while leaving many seniors vulnerable.
Federal policymakers must take a hard look at the harmful practices of corporate insurance companies and reform the current system to make 24/7 care more accessible and affordable for seniors and patients nationwide.