A recent audit by the Department of Health and Human Services (HHS) Inspector General highlights the need for stronger oversight of Medicare Advantage home visits, which led to billions in additional payments for diagnoses that didn’t result in further treatment. In 2023 alone, Medicare Advantage plans billed $7.5 billion for such diagnoses, with $4.2 billion tied to home health assessments.

Concerns About Medicare Advantage Home Visits

The audit suggests that some Medicare Advantage plans may be inflating costs by diagnosing health issues during home visits that are not followed by necessary care. These visits allow providers to claim higher reimbursements, despite conditions often not being treated. UnitedHealthcare, the largest Medicare Advantage provider, accounted for a significant share of payments tied to these home assessments. Assistant Inspector General Erin Bliss called for stricter oversight, saying, “This needs to stop.”

The Need for Stronger Medicare Advantage Oversight

Although the audit recommended limiting payments based on home assessments, the Centers for Medicare & Medicaid Services (CMS) has pushed back, emphasizing the value of identifying conditions through these visits. CMS spokesperson Alexx Pons noted that home-based assessments can help ensure Medicare beneficiaries receive proper care, though the agency will keep monitoring this area.