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Humana (NYSE:HUM), the second-largest Medicare Advantage insurer behind UnitedHealth (UNH), has informed congressional staffers it plans to back measures that would curb billing practices generating billions of dollars in additional payments to the industry, according to The Wall Street Journal.
According to a one-page policy overview and congressional staffers, Humana (NYSE:HUM) has informed congressional staff members that the company is prepared to back curbs on extra payments that insurers receive from diagnoses recorded through home visits conducted by nurse practitioners.
The Louisville, Kentucky-based managed care firm has also suggested reforms to the Medicare insurers’ practice of reviewing patients’ medical charts to arrive at diagnoses.
The company has said that the practice, known as Health Risk Assessments through chart reviews, shouldn’t lead to payments for diagnoses based on chart reviews without any specific medical encounters.
UnitedHealth (UNH) and CVS Health (CVS) operate HouseCalls and Signify Health, units focused on conducting HRAs through visits to their Medicare enrollees’ homes. Other insurers with large Medicare Advantage businesses include Cigna (CI) and Alignment Healthcare (ALHC).
In October, the Office of Inspector General accused UnitedHealth (UNH), Humana (NYSE:HUM), and other Medicare firms of collecting as much as $7.5B in payments in 2023 by conducting annual HRAs without any follow-up.
HRAs conducted through home visits made up the largest portion of those extra payments, the OIG’s report highlighted.