A newly released audit found little evidence that UnitedHealth’s HouseCalls program inflated Medicare reimbursements through unnecessary diagnoses. The independent review examined home visit records and confirmed that most diagnoses matched patients’ medical histories.
FTI Consulting reported that 96.6% of diagnoses made during HouseCalls visits were supported by medical records. Only 3.4% lacked direct documentation, a rate significantly lower than the error rate identified in recent CMS Medicare Advantage audits.
UnitedHealth also stated that several initially unsupported diagnoses were later verified through paid insurance claims. The company believes these findings reinforce the program’s accuracy and its focus on preventive healthcare for Medicare beneficiaries.
HouseCalls Continues to Face Regulatory Scrutiny
UnitedHealth says HouseCalls helps clinicians detect health issues that may not appear during routine doctor visits. The company believes these in-home assessments improve preventive care and help patients receive timely medical attention.
Critics argue that Medicare Advantage payment rules create financial incentives for insurers to report additional diagnoses. They believe programs like HouseCalls may encourage insurers to increase reimbursements through extensive health assessments.
A 2024 government investigation found billions of dollars in questionable Medicare Advantage payments tied to home health assessments. UnitedHealth received the largest share of those payments, increasing regulatory attention on the program.
FTI Review Highlights Strong Compliance
Following increased public scrutiny, CEO Stephen Hemsley commissioned an independent review of UnitedHealth’s business practices. Earlier findings identified opportunities for improvement but found no evidence of widespread misconduct.
FTI Consulting reviewed 200 HouseCalls visits covering 494 diagnoses. Auditors initially questioned 17 diagnoses, but additional claim data later confirmed 12 of them, reducing the number of unsupported findings.
UnitedHealth did not disclose the financial impact of the remaining unsupported diagnoses. However, company officials emphasized that the audit demonstrates a high level of compliance and responsible reporting practices.
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UnitedHealth Pledges Ongoing Transparency
UnitedHealth says the audit confirms the integrity of its HouseCalls program while recognizing that continuous improvement remains important. The company plans to strengthen its review processes and maintain accurate diagnosis reporting.
CEO Stephen Hemsley said independent evaluations of key business practices will continue. Future audit findings will also be shared publicly to improve transparency and reinforce trust with regulators and Medicare beneficiaries.
As oversight of Medicare Advantage programs increases, independent audits are expected to play a larger role. The latest HouseCalls review offers insight into diagnosis accuracy and may influence future compliance standards across the healthcare industry.
