If you’re enrolled in a Medicare Advantage plan and are in fair or poor health, it is more than likely that your health plan will ask whether it can do a home risk assessment. Should you allow your health plan into your home?
Tia Sawhney writes for Newsweek on the pros and cons of allowing your Medicare Advantage plan insurer into your home. You should know that you do not have to let anyone into your home, nor do you need to have a health assessment if you don’t want one. If you have one, it should benefit you. So, be sure to ask whether the visiting nurse will treat any conditions she finds and whether your Medicare Advantage plan will let your primary care doctors know about any new conditions found.
Best case, the insurer will learn more about your health conditions, including safety risks in your home if you allow the insurer in. And, the insurer might even take steps to improve your health and mitigate safety risks. You should get a written summary of the nurse’s assessment. If the nurse turns up a new diagnosis, you should let your primary care doctor know. Don’t assume your Medicare Advantage plan will do so.
The insurer has another reason to visit your home, which is neither in your interest nor in the interest of the Medicare program. Insurers can profit handsomely off these home visits if they can use them to add diagnosis codes to your medical records or change diagnosis codes to make your condition appear more severe. The insurers’ only interest could be financial.
The government pays the Medicare Advantage plans more for enrollees with more severe conditions reflected on their medical records, even if the health plans do not treat the conditions. Payments to Medicare Advantage plans are completely unrelated to the cost of services they deliver. To maximize profits, they can “upcode” or enter more diagnosis codes in people’s records and then spend as little as possible on their care.
The problem of “upcoding” is widespread and massive, leading by some projections to $40-$75 billion in MA overpayments this year alone. The Justice Department has charged all the biggest insurers offering Medicare Advantage plans with upcoding and fraud, for wrongly adding diagnosis codes to patient records or not properly documenting diagnosis codes. At the end of 2022, the US Attorney in Manhattan charged Cigna with using home assessments purely to add invalid and false diagnosis codes to patients’ records.
Cigna allegedly did not even permit the nurses doing home assessments to treat patients they visited at home. And, Cigna and other medical providers who treated these people did not even see their revised medical records.
Here’s more from Just Care:
- New study finds you can’t meaningfully choose among Medicare Advantage plans
- Medicare Advantage endangers rural hospitals
- Hospitals dropping Medicare Advantage because of concerns with patient care
- Be a Hero tells Congress to end Medicare Advantage wrongful delays and denials of care
- Corporate health insurers use NaviHealth algorithms to deny care in Medicare Advantage plans
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