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Medicare Advantage plans received $4.2 billion in payments for questionable home visits, report says
Medicare Advantage plans reaped $4.2 billion in extra payments last year by making home visits to senior citizens who may not have received treatment for serious health issues, a new government report has found.
The report, issued by the Office of Inspector General for the Department of Health and Human Services, flags concerns with so-called health risk assessments, or HRAs, which are home visits used to diagnose Medicare enrollees for serious health issues.
Because senior citizens who suffer from major health issues can trigger higher risk-adjusted payments for Medicare Advantage plans, the agency wanted to determine whether these HRAs are misused, with taxpayers footing the bill. Roughly half of the 66 million seniors enrolled in Medicare are also enrolled in a Medicare Advantage plan, which are offered by private insurers such as UnitedHealthcare and Humana.
The analysis said UnitedHealthcare collected $3.7 billion of risk-adjusted payments last year, making it the biggest benefactor of the practice, followed by Humana, with $1.7 billion. Neither UnitedHealthcare nor Humana immediately responded to requests for comment.
The report raises concerns about how Medicare Advantage (MA) plans are using HRAs, as well as the amount of taxpayer spending linked to these home visits. About 1.7 million people who are enrolled in Medicare Advantage plans received these home visits last year but had no follow-up visits, procedures, tests or supplies for their diagnoses, which suggests the payments may have been “improper” or that enrollees didn’t receive needed care, the report concluded.
In addition to potential overpayments for HRAs, Medicare Advantage plans may also be receiving additional billions from so-called HRA-linked chart reviews. These occur when a Medicare Advantage company later reviews a senior citizen’s medical record to look for diagnoses that a provider didn’t submit or may have submitted in error.
“In-home HRAs and HRA-linked chart reviews may be more vulnerable to misuse because these tools are often administered by MA companies or their third-party vendors and not enrollees’ own providers,” the report noted. “Diagnoses reported only on these types of records heighten concerns about the validity of the diagnoses or the coordination of care for MA enrollees.”
Medicare paid private insurers operating Medicare Advantage plans about $7.5 billion last year for diagnoses reported via both HRAs and HRA-linked chart reviews, the report found.
A $1,869 home visit
Each in-home HRA generates about $1,869 in estimated risk-adjusted payments, the report found. By comparison, Medicare Advantage plans receive about $365 in payments when patients visit a doctor’s office or other health care facility.
Thirteen health conditions produced $5.6 billion of the $7.5 billion in risk-adjusted payments for Medicare Advantage plans, with vascular disease linked to almost $1 billion of these payments, the most of any diagnosis, the analysis found.
But at-home diagnoses aren’t always backed up by visits to a doctor or health care facility, the analysis found. For example, Medicare Advantage companies diagnosed “secondary hyperaldosteronism,” an adrenal gland issue, in 74% of enrollees with this diagnosis through a home visit or HRA-linked chart review that resulted in payment.
Only 3% of enrollees received this diagnosis through a visit to a doctor’s office or other health care facility.
Twenty Medicare Advantage companies generated about 80% of $7.5 billion in risk-adjusted payments, the analysis found. The report flagged UnitedHealth Group, saying it “stood out from its peers, especially in its use of in-home HRAs and HRA-linked chart reviews to generate risk-adjusted payments.”
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Gold’s meteoric rise in 2024 has captured the attention of investors across the globe, as the precious metal has shattered numerous price records and posted gains of about 33% year-to-date — far outpacing the returns on more traditional investments. This remarkable performance hasn’t just been appealing to seasoned investors, either. It has also sparked interest among newcomers to the investment world, many of whom see the potential for significant returns in an asset traditionally known more for stability than dramatic growth.
The allure of gold in today’s market is understandable. Watching an investment vehicle post consistent gains can make the decision to invest seem straightforward, particularly for those just beginning their investment journey. However, the decision to invest in gold requires more nuanced consideration than simply following market momentum. While gold’s recent performance might suggest an easy path to profits, its role in an investment portfolio is complex and multifaceted.
And the current market dynamics present both opportunities and challenges for beginners, in particular. After all, the confluence of factors driving gold’s price appreciation creates a complex landscape that can be difficult to navigate. So should beginners take the plunge and add gold to their portfolios this November? That’s what we’ll break down below.
Compare your gold investing options here.
Should beginners invest in gold this November?
While the decision to invest in gold is ultimately a personal one based on factors like your investment goals and diversification needs, there are a few good reasons to consider buying in as a beginner, including:
The potential for short-term price growth
Gold is typically seen as a long-term investment, but the past year has presented a unique opportunity for short-term gains. The price of gold has surged from about $2,064 per ounce on January 1 to where it sits today at about $2,745 per ounce (as of October 24, 2024). And while that’s an impressive price run, there’s a good chance it’s not over. Many analysts expect that the price of gold could exceed $3,000 by the end of the year, meaning that beginners have a rare chance to invest now and potentially turn a quick profit in the coming weeks or months.
So, if you’re new to investing and looking for a way to capitalize on market trends, gold could provide a relatively low-risk opportunity for significant returns in the short term. While it’s generally advisable to hold onto gold for the long run, current market conditions offer a window for quicker profits, making this November an opportune time to get involved.
Protect your portfolio with gold today.
The protections it offers during uncertain times
Geopolitical tensions are running high as the year draws to a close, with conflicts and global uncertainty making financial markets more unpredictable. That’s where gold can come in handy, especially for beginners. Gold has historically been seen as a safe haven during times of geopolitical unrest, as its value tends to rise when other assets face volatility or decline due to external shocks. So for beginners looking to safeguard their portfolios against unpredictable global events, gold offers a layer of protection.
Whether it’s trade disputes, political instability or other conflicts, these factors can negatively affect traditional assets like stocks and bonds. By investing in gold, beginners can shield their portfolios from sudden downturns caused by such events. November is an especially relevant time to consider this, as upcoming political events could lead to more market swings. Owning gold in such times provides a cushion against potential disruptions.
The affordability and accessibility it offers
Another appealing aspect of investing in gold as a beginner is the variety of ways you can invest in it. Whether your goal is to buy physical gold, invest in a digital asset like a gold exchange-traded fund (ETF) or gold stocks or something else entirely, gold can be an accessible option regardless of your budget, as there are plenty of opportunities to get exposure without needing a large sum of money upfront.
For beginners, this flexibility is a huge advantage. You can start small by purchasing fractional shares of gold ETFs or gold-based mutual funds, allowing you to dip your toes into the precious metal market without committing significant capital. This makes November an ideal time for new investors, as it allows you to participate in the ongoing price surge while tailoring your investment to your financial situation.
The bottom line
Investing in gold this November presents a unique opportunity for beginners. Whether you’re looking to turn a quick profit as gold prices continue to rise or are simply trying to find an affordable, accessible entry point into the precious metals market, gold offers both short-term and long-term benefits. By adding gold to your portfolio, you’ll also gain valuable diversification that can help protect your investments during periods of economic uncertainty. As with any type of investment, though, just make sure you’ve fully researched your options and are sure it’s the right move for your money.
