An independent audit of UnitedHealth's HouseCalls program found that nearly 97% of diagnoses made during home visits to Medicare seniors were supported by patients' medical records. The review, conducted by FTI Consulting, comes amid ongoing scrutiny over whether the program inflates Medicare Advantage reimbursements. UnitedHealth says the results vindicate the program, while critics remain skeptical.
An independent audit of UnitedHealth's HouseCalls program — which sends clinicians to perform annual in-home health assessments for Medicare seniors — found that 96.6% of diagnoses identified during those visits were backed by patients' medical records. The review, commissioned by UnitedHealth and conducted by FTI Consulting, comes as the program faces intense regulatory and congressional scrutiny over allegations that it generates diagnoses to inflate Medicare Advantage (MA) reimbursements.
UnitedHealth says the results are a clear sign of the program's integrity. CEO Stephen Hemsley acknowledged room for improvement but reaffirmed the value of home visits in helping seniors avoid costly medical emergencies. Critics, however, argue that in-home risk assessments remain a key vehicle for insurers to game MA payment formulas — which adjust payouts based on patient illness severity.
By the Numbers:
Why it matters: With billions in federal Medicare dollars tied to diagnosis coding, the integrity of home-visit programs like HouseCalls has major implications for government spending, insurer accountability, and the future of Medicare Advantage oversight.
