I got a call from a client who is very annoyed by phone calls from her Medicare Advantage plan asking her to agree to a home visit from a company nurse. Asta asked me if she had to comply with her Medicare Advantage plan’s request to have a nurse visit with her.
Asta is a healthy 70-year old. She is not interested in having a nurse come to her house to examine and interview her. She has told the company she does not want a visit, but she keeps getting the calls.
I wrote about a similar situation three years ago: https://medicareblog.org/medicare-advantage-the-doctor-would-like-to-visit/
The reason for the Medicare Advantage home visit is mainly to get a health assessment for each Medicare Advantage member so the company can identify individuals who might be sicker than most. If they find a person has one or more chronic illnesses, the Advantage plan will get more money from Medicare for that person. This is called “risk adjustment”.
Risk Adjustment Controversy
Medicare Advantage plans have been getting less money from Medicare each year because of the Affordable Care Act. I wrote about this back in 2010: https://medicareblog.org/obamacare-and-medicare-what-has-changed/
Medicare Advantage plans have also been getting more money from Medicare because of risk adjustment payments.
Humana is being investigated by the Department of Justice for possibly overstating the negative health conditions of some of its Medicare Advantage plan members. One focus of the investigation is a doctor who was hired by Humana to carry out risk assessment home visits. A Medicare audit showed this doctor reported people to have medical conditions that did not match their medical records. The doctor’s reports got higher payments for Humana from Medicare – and if they were false, a crime was committed.
All Medicare Advantage plans are being audited because Medicare has seen an upward trend when it comes to what it is paying out for risk adjustments. But the Medicare Advantage plans keep calling their members to set up homes visits.
I have had calls from several clients who asked me if these Medicare Advantage home visits are legitimate. Asta is just the latest one to call. I told her to respond to the last message she got on her phone and tell them to stop calling her. I think this will result in a note being put in her record that she should not be bothered in the future.
Medicare has lots of rules for Medicare Advantage plans when it comes to contacting their members. Seniors should not be worried about the consequences of telling their Medicare Advantage plan to buzz off..