Medicare gave private insurers about $4.2 billion for debatable diagnoses during home visits: report

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Medicare gave roughly $4.2 billion to private insurers last year for health diagnoses from home visits that didn’t get treatment, according to an inspector general’s report.

The funding stemmed from doctor visits in which patients received no services, apart from diagnosis, according to an exclusive report from The Wall Street Journal, 

The inspector general’s report showed that each visit was worth $1,869 on average to the insurers.

There are other concerns that some of the diagnoses were false. The OIG recommended that Medicare cut off or at least restrict payments for the diagnoses that occurred from these visits. 

Medicare pushed back on the OIG’s recommendation and told the Journal that it is dedicated to ensuring that diagnoses are accurate. 

“We’re seeing that some Medicare Advantage companies are making billions from the health risk assessment diagnoses without providing care for the conditions that they identify,” Erin Bliss, assistant inspector general for evaluation and inspections, said, according to The Wall Street Journal.