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Healthcare Dive Op-Ed by Christi A. Grimm: Medicare Advantage should not 'game the system' but prioritize patient care, honest billing

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By Christi A. Grimm, Principal Deputy Inspector General, HHS-OIG

We all agree healthcare providers should prioritize patient well-being and bill honestly. Most do. But, if not, my office, the Office of Inspector General for the HHS, and other government agencies, are watching.

We are especially monitoring an area of concern: abuse of risk adjustment in Medicare Advantage, the managed care program serving 23 million beneficiaries, 37% of the Medicare population, at a cost of about $264 billion annually. We have good reason to pay attention. Our recent report found that Medicare Advantage paid $2.6 billion a year for diagnoses unrelated to any clinical services.

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