A September HHS Office of Inspector General report found 20 insurers received about half of a $9.2 billion pool of suspicious Medicare payments over a year, but a new statement from the office ties the largest portion of those funds going to UnitedHealth Group.
While the initial report kept payers anonymous, the office responded to a Star Tribune inquiry, revealing to the publication that UnitedHealth Group was payer from the report who covered 22 percent of of all beneficiaries enrolled, but received 40 percent, or $3.7 billion, of the questionable payment pot in 2017. At the time, UnitedHealth Group insured 22 percent of beneficiaries.
"[The Office of Inspector General's] report is based on old data and is inaccurate and misleading — a disservice to seniors and an attack on the CMS payment system," a UnitedHealth Group spokesperson told Becker's. "In-home clinical care programs and chart reviews are needed for appropriate senior care and payment. UHC's status as an early clinical home provider is not only appropriate, it’s best practice."
The initial report recommended that companies found to be receiving questionable payments be investigated but did not declare whether or not they were engaging in fraud.
This story will be updated as new information becomes available.
OIG’s report is based on old data and is inaccurate and misleading--a disservice to seniors and an attack on the CMS payment system. In-home clinical care programs and chart reviews are needed for appropriate senior care and payment. UHC’s status as an early clinical home provider is not only appropriate, it’s best practice.