The country’s second biggest Medicare Advantage (MA) insurer supports new limits on payments from diagnoses recorded by nurse practitioners during home visits, according to an exclusive report by the Wall Street Journal.
Sources told the publication that the company has been working on proposed reforms for months since Senate Finance Committee leaders reached out to MA insurers for steps lawmakers could take to address the potential misuse of home visits that the newspaper described in a series of articles this past year.
According to recent WSJ investigations, hour-long home nurse visits from 2019 to 2021 turned into an average of $1,818 in extra payments per visit. In total, the payments added up to $15 billion during the two-year period, about 30 percent of the $50 billion in payments for questionable diagnoses the newspaper previously reported.
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UnitedHealth, the largest MA insurer in the United States, received $2,735 in extra Medicare payments for the visits, nearly three times the average for all other MA insurers, according to WSJ. Humana received $1,525 in payments per home visit. Nurses told the publication that they were trained to record questionable diagnoses during the visits.
According to a document that Humana shared with congressional staff, the company suggests that insurers get paid for the diagnoses in insurer-initiated home visits only if they are documented elsewhere. In addition, Humana has suggested that insurers receive payments for diagnoses from chart reviews only if they are linked to specific medical encounters.