Episode 94: Is Adding a Diagnoses to a Medicare Advantage Patient FWA or a Positive Step in Social Determinants of Health (SDOH)

by | Sep 11, 2024

OIG Roundtable
OIG Roundtable Podcast
OIG Roundtable (Formerly Retro Fraud)
Episode 94: Is Adding a Diagnoses to a Medicare Advantage Patient FWA or a Positive Step in Social Determinants of Health (SDOH)
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Eric and Wade discuss a recent Wall Street Journal article that discussed the fact that Medicare Advantage payors are having contracted healthcare providers affirmatively visit, examine and diagnose members with conditions that were potentially unknown to the members’ primary care provider. Is this manipulation of risk scores or SDOH related?