Medicare Advantage organizations’ use of chart reviews to elevate risk scores has been under increasing scrutiny since the Dept. of Justice in 2017 notoriously intervened in two whistleblower lawsuits, which accused UnitedHealth Group of purposely ignoring certain chart-review data that resulted in overpayments. Now, a new HHS Office of Inspector General (OIG) report calls attention to the widespread use of chart reviews to add diagnoses, and it estimates that this practice boosted risk-adjusted payments by $6.9 billion in 2017. But CMS argues that OIG’s calculations are overstated, and industry experts say the bigger issue at hand is whether chart-review records should play a more meaningful role in CMS audits going forward.
To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.