Medicare Advantage (MA) insurers, namely industry titans UnitedHealth Group and Humana, could be using health risk assessments and chart reviews to inflate payments from Medicare through upcoding, according to a federal watchdog report. An estimated $7.5 billion in risk-adjusted payments was pocketed by MA insurers when diagnoses were only found on chart reviews but no other service records. At-home visits and chart reviews make up $4.2 billion of the total payments from the government to MA insurers in fiscal year 2023, yet at-home visits make up just 13% of all chart reviews in 2022, the report (PDF) from the Department of Health and Human Services Office of Inspector General (OIG) found.
Oracle Health to join interoperability network
Oracle Health said it intends to obtain the Qualified Health Information Network designation under the Trusted Exchange Framework and Common Agreement, known as TEFCA. According to an Oct. 28 news release, the EHR vendor has begun the process to achieve Qualified Health Information Network status. With this, Oracle Health will be able to facilitate seamless and secure health information exchange for its healthcare clients.
Today, the U.S. Department of Veterans Affairs announced it delivered more care and more benefits to more Veterans than ever before in fiscal year 2024 — exceeding last year’s record totals. These outcomes for the nation’s Veterans build on continued efforts by VA and the Biden-Harris Administration’s Unity Agenda to expand and improve care and benefits for those who served, much of which has been made possible by the PACT Act — the largest expansion of VA health care and benefits in generations.
The Peterson Health Technology Institute, an independent evaluator of digital health technologies, released a report on hypertension solutions Monday that put a crater in the remote monitoring industry. The report lauds remote monitoring solutions that include medication management while it raises question about other digital approaches to hypertension management. Both groups of companies claim they have strong evidence to show that their solutions have a meaningful impact on patient outcomes and cost savings for providers and payers.
The Department of Health and Human Services submitted proposed updates to the 20-year-old HIPAA Security Rule to the White House for review, aiming to enhance the cybersecurity protections for electronic health information, GovInfoSecurity reported Oct. 23. The main goal of the proposed changes is to improve cybersecurity for organizations covered by HIPAA, Marissa Gordon-Nguyen, senior advisor for health information privacy, data, and cybersecurity at the HHS' Office for Civil Rights said during a HIPAA summit.
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