Home Health Care News reports:
Health plans are cashing in on home visits, taking advantage of Medicare profits when the house calls unearth patients’ medical problems, according to a report by The Center for Public Integrity, a nonprofit investigative news organization in Washington, D.C., reports Home Health Care News.
Some senior citizens are finding that their Medicare Advantage health plans were eager to send a doctor to visit them at home, a service that is part of a burgeoning medical information and data analysis industry that’s thriving behind the scenes. Health plans profit because Medicare pays them higher rates for sicker patients, using a billing formula known as a “risk score,” The Center for Public Integrity reports.
Medicare made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013, “mostly overbillings based on inflated risk scores,” the investigation shows.
Doctors and nurses who visit patients’ homes don’t offer any treatment during their visits, but report their findings to primary care physicians. And when a home visit uncovers a medical condition, health plans may raise a person’s risk score and cash in on thousands of dollars in added Medicare revenue, even if they don’t incur additional expenses when treating the patient. More than 70 health conditions may push up the risk scores, and thus the payments made by Medicare. Read more