The Dirty Little Secret About The Medicare Advantage Home Nurse Visit

Lately, I have had several of my senior patients happily tell me that they had a home visit from a nurse who was sent to them by their Medicare Advantage Insurance company to check on them and see what they could do for them.  They felt that it was very thoughtful of their insurance company to care so much about them to do this.

As the late, great Paul Harvey used to say, “And now, the rest of the story…”  The kind and oh so thoughtful insurance companies seem to overlook mentioning something when they send the nurses out to the patient’s home…IT IS ALL ABOUT THE MONEY.

The Medicare Advantage carriers are sending these nurses into the patient’s home first and foremost to gather information about the patient.   They look to document any medical conditions that may not have shown up on any of their claims data derived from their doctor’s billing records.  They do this because the more problems they document, the higher that patient’s “risk score” will be.  The sicker and riskier a patient appears, even if they are in reality pretty healthy, the more that insurance company can demand from Medicare to cover the cost of the patient’s care in the coming year.

To be completely honest, there have been a few occasions where the nurse was able to pick up on something that did need to be addressed, and the patient did benefit.  This is all well and good.  My issue with the whole process is how disingenuous and hypocritical the insurance companies are being.  They are perfectly happy to have the patients believe that they are doing these home visits as a public service because they care so much, when really they are looking to line their own pockets (even more than they already have) with our tax dollars.

Please don’t get me wrong.  I am all in favor of a company making a profit.  My problem with this practice is that a company already in bed with the government is lobbying the same government for more of the taxpayers’ money.  It is the definition of crony capitalism. Their deception in selling their actions as being all for the good of their clients and the public in general, when their true priority is their own self interest is disgusting.

Health insurance companies being sleazy, greedy, and deceptive…Who would have thought?!

For a more in depth analysis of this, please visit: The Center For Public Integrity


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