How to get started with Airtel Caller tunes
One insurer, which was not named, brought in 40% of risk-adjusted payments through these mechanisms, despite accounting for just 22% of MA beneficiaries.
“We undertook this evaluation because of concerns that companies with contracts under Medicare Advantage may leverage both chart reviews and health risk assessments to maximize risk-adjusted payments, without beneficiaries receiving care for those diagnoses,” OIG wrote in the report. “Unsupported risk-adjusted payments have been a major driver of improper payments in the MA program.” RELATED: CVS: OIG conducting audit of Aetna’s Medicare Advantage plans Each generated a share of payments using chart reviews and HRAs that were 25% higher than their share of MA beneficiaries. According to the OIG report, 20 of the 162 MA insurers included in the study drove the bulk of the $9.2 billion in overpayments.