A recent report
[1] released by the U.S. Department of Health & Human Services Office of Inspector General found that billions in Medicare payments were paid out for risk assessments performed by third parties, often in-home assessments, which may have exaggerated risks and not resulted in more care.
Christi Grimm, principal deputy inspector general of the Office of Inspector General, published an opinion piece to accompany the report,
[2] in which she pointed out that government agencies such as hers were aware of the issue and would be scrutinizing risk adjustments going forward. She wrote that risk adjustments were necessary in order to differentiate care between different beneficiaries, but if those assessments were profit driven, as opposed to care driven, then providers could face investigations and possible enforcement actions.
Report on Medicare Compliance 29, no. 43 (December 7, 2020) - In a new provider compliance audit, the HHS Office of Inspector General (OIG) said The Palace at Home, a.