Medicare Advantage plans received $4.2 billion in payments for questionable home visits, report says

Medicare Advantage plans reaped $4.2 billion in extra payments last year by making home visits to senior citizens who may not have received treatment for serious health issues, a new government report has found.

The report, issued by the Office of Inspector General for the Department of Health and Human Services, flags concerns with so-called health risk assessments, or HRAs, which are home visits used to diagnose Medicare enrollees for serious health issues. 

Because senior citizens who suffer from major health issues can trigger higher risk-adjusted payments for Medicare Advantage plans, the agency wanted to determine whether these HRAs are misused, with taxpayers footing the bill. Roughly half of the 66 million seniors enrolled in Medicare are also enrolled in a Medicare Advantage plan, which are offered by private insurers such as UnitedHealthcare and Humana.