UnitedHealth Group brought in an estimated $3.7 billion in payments linked to health risk assessments and chart reviews in 2023, according to an audit published by HHS' Office of Inspector General.
The audit, published Oct. 24, examined "questionable" payments linked to health risk assessments and chart reviews.
Medicare Advantage plans conduct HRAs to collect information about enrollee health status. These assessments are sometimes conducted by providers as part of beneficiaries' annual wellness visits, or in enrollees homes. MA plans also conduct chart reviews to find diagnoses that may have been missed by providers during visits.
MA plans are reimbursed by the federal government based on enrollees' health risk. The policy creates financial incentives for insurers to "misrepresent" enrollees' health status by submitting unsupported diagnoses, according to the OIG's audit.
Just 20 companies accounted for 80% of the estimated $7.5 billion in payments MA insurers received through HRAs. These companies had an outsized share of payments linked to HRAs compared to their enrollment, according to the OIG.
Collectively, the 20 companies accounted for 50% of MA enrollment, but 80% of HRA payments.
In a statement published Oct. 24, Mary Beth Donahue, president and CEO of the Better Medicare Alliance, said the report "paints a misleading picture of in-home health assessments." The Better Medicare Alliance is backed by major insurers.
"Medicare Advantage is designed to achieve a better overall understanding of individuals' health, and in-home assessments are a crucial part of this model," Ms. Donahue said. "This information ensures seniors get the resources they need. We have supported codified best practices for these assessments and will continue to do so."
Here are the companies with the largest HRA payments, outsized according to their enrollment, according to the OIG:
- UnitedHealth Group: $3.7 billion
- Humana: $1.7 billion
- Cigna Group: $237 million
- SCAN Group: $127.6 million
- Alignment Healthcare: $60 million
- Independent Health: $38.7 million
- Viva Health (Triton Health Systems): $23.7 million
- Intermountain Health Care: $18.5 million
- HealthPartners: $15.9 million
- Hometown Health Plan (Renown Health): $7.2 million
See the full report here.