The federal government has expanded its investigation into DaVita HealthCare Partners' Medicare Advantage risk-adjustment practices, DaVita revealed in a Securities and Exchange Commission filing Wednesday.
DaVita said in the filing that HHS' Office of Inspector General recently issued a subpoena seeking documents related to DaVita and its subsidiaries' services to Medicare Advantage plans and organizations and “related patient diagnosis coding and risk adjustment submissions and payments” from 2008 to present. The company operates a large multispecialty medical group in addition to its main dialysis business.
In recent years, some have accused Medicare Advantage plans of inflating risk scores to earn more money. The CMS pays Advantage plans based partly on risk scores, which reflect the health of patients. Sicker patients mean higher risk scores and higher payments to insurers.
DaVita said in a statement that the civil inquiry primarily focuses on HealthCare Partners, which DaVita acquired in 2012.
“Accurate patient diagnosis and coding are critical aspects of the MA program because they help make sure that the most at risk patients are identified and appropriately treated and that reimbursement programs cover those costs,” DaVita said in the statement. “We are a leader in this space and we have invested significantly in both the clinical and compliance discipline of this critical aspect of the MA program.”
DaVita said some of the requested information relates to a previously disclosed, potentially improper HealthCare Partners coding practice. DaVita said that practice was stopped after it acquired HealthCare Partners, and DaVita notified the CMS about it. DaVita established an escrow fund to address such issues when it acquired HealthCare Partners, the company said.
DaVita also said in its filing that it believes the subpoena to be part of a broader government investigation into patient diagnosis coding and risk-scoring practices across the industry.
“We know the government has been taking a systematic, industry-wide look at diagnosis and billing aspects of the program and we have been intensely focused on these issues since before the acquisition of HCP,” DaVita said in its statement.
The news Wednesday follows DaVita's disclosure in March that the OIG had subpoenaed JSA HealthCare Corp., a subsidiary of the HealthCare Partners division of DaVita. That subpoena related to an ongoing investigation into the risk-adjustment practices of Humana's Medicare Advantage and its service providers, including how patient diagnoses were determined.
