The U.S. Department of Health & Human Services Office of Inspector General (OIG) September 2020 report titled Billions in Estimated Medicare Advantage Payments From Diagnoses Reported Only on Health Risk Assessments Raise Concerns^[1] found that Medicare Advantage organizations (MAOs) received an estimated $2.6 billion in risk-adjusted payments for 2017 from diagnoses reported only on health risk assessments (HRAs)—and on no other service records.

These payments are being questioned. MAOs receive higher risk-adjusted payments based on diagnoses for Medicare beneficiaries expected to have greater healthcare needs.