Opinion: Medicare Advantage Should Not 'Game the System' but Prioritize Patient Care, Honest Billing

Intro by Robert Yates, Deputy Attorney General

A recent HHS-OIG report found that Medicare Advantage paid $2.6 billion per year for diagnoses unrelated to any clinical services, fueled by businesses who generate revenue through identifying additional patient diagnoses after conducting health risk assessments. Foreshadowing the federal government’s enforcement priorities in this area, Principal Deputy Inspector General Christi Grimm identifies two main causes for concern with providers “gaming the system” through health risk assessments—bad data and suboptimal care—and outlines advice to keep providers out of the government’s cross-hairs. See the full story here.

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