A month after its bombshell report that Medicare Advantage (MA) insurers were paid billions for diseases that patients never had, The Wall Street Journal (WSJ) has published a new investigation into the lucrative practice of one-hour nurse visits to Medicare recipients’ homes.
The latest piece investigates insurer home visits conducted by nurses. According to the publication’s analysis of Medicare data (information provided to the WSJ under a research agreement with the federal government), the hour-long nurse visits from 2019 to 2021 turned into an average of $1,818 in extra payments per visit. In total, the WSJ found the payments added up to $15 billion during the two-year period, about 30 percent of the $50 billion in payments for questionable diagnoses that the publication reported last month.
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Insurers told the publication that the home visits help patients because they can catch diseases early and ensure patients are taking their medicine as prescribed. The visits also allow nurses to perform tests. But for UnitedHealth, the largest MA insurer in the country, it also meant $2,735 in extra Medicare payments, nearly three times the average for all other MA insurers, the WSJ reported.
To encourage MA members to agree to a home visit, call centers would contact them several times a day and offer them gift cards. If the patient agreed, nurses would come to their homes and ask questions about their medical history and medications and conduct a physical assessment. Once nurses entered the information into a laptop or tablet, the software used would suggest a diagnosis.
The WSJ found that one diagnosis—secondary hyperaldosteronism, which is rarely found in traditional Medicare patients—was reported by UnitedHealth 246,000 times after home visits. The diagnosis led to $450 million in payments in 2019-2021 to the insurer. Even without that diagnosis, the home visits were profitable for UnitedHealth. The WSJ found that 60 percent of their home visits led to “at least one new revenue-producing diagnosis of a condition no doctor was treating.” Humana, the second largest MA insurer in the country, found home visits led to a new diagnosis in 39 percent of the cases.
In response, the Centers for Medicare & Medicaid Services told WSJ that it has increased audits to verify diagnosis and also is removing some diagnoses that qualify for extra payments.