News Briefs: OIG Audits Will Focus on Unlinked Chart Reviews in MA

The HHS Office of Inspector General will conduct a series of Medicare Advantage audits focused on diagnoses identified from unlinked chart reviews that resulted in higher risk-adjusted payments to MA organizations. For the risk adjustment program, CMS allows Medicare Advantage organizations to conduct chart reviews of enrollee medical record documentation to identify diagnosis codes that providers either did not originally give the MAO or provided in error. With unlinked chart reviews, MAOs do not have to include the specific date of service for previously unidentified diagnosis codes. In a 2021 report suggesting some MAOs were relying heavily on chart reviews and health risk assessments to achieve higher risk-adjusted payments, OIG previously recommended that CMS reassess whether it should allow unlinked chart reviews to be sole sources of diagnoses for risk-adjusted payments. The audit reports are expected to be released in 2026, according to a work plan summary posted this month.

© 2024 MMIT
Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

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