UnitedHealth Group (NYSE: UNH) and Humana (NYSE: HUM) are pushing to increase oversight and limit payments to insurers for in-home clinical assessments in Medicare Advantage (MA).

On Friday, UnitedHealth called to increase MA oversight of in-home clinical visits and deploy annual audits focused on in-home clinical visits. Humana told congressional staffers that it supported limiting payment for diagnoses made by nurse practitioners during home visits and that diagnoses recorded only in home visits initiated by the insurer should not generate additional payments, according to the Wall Street Journal. These payments are worth billions, according to the WSJ. 

“UnitedHealth Group has long advocated for thoughtful, forward-looking solutions to modernize and strengthen Medicare Advantage, especially in the areas around accountability, transparency and clinical value,” the company said in a statement. “UHG supports policies that hold in-home clinical visits to the highest standard and are supportive of a wide range of solutions that modernize in-home clinical assessments.”

Specifically, UnitedHealth said it supported:

– Ensuring that beneficiaries who receive new diagnoses during in-home clinical visits receive follow-up care within a specified timeframe

– Requiring that health plans connect beneficiaries to care coordination programs and benefits

– Standardizing in-home clinical assessments to adhere to CMS best practices

– Increasing program oversight through enhanced reporting and transparency

– Instituting annual audits focused on in-home clinical visits

UnitedHealth recently reiterated its support for more frequent audits of MA plans in leaked documents. The company is also reportedly under investigation for its Medicare Advantage billing practices. The company has said that it “stands firmly” behind the integrity of its MA program.

UnitedHealth and Humana beneficiaries account for 47% of all MA enrollees nationwide, according to KFF. 

The Better Medicare Alliance, an advocacy group for Medicare Advantage, stated on Friday that cuts to MA would be dangerous for older adults.

“Cutting Medicare Advantage, and particularly in-home care, would break a promise to millions of seniors who rely on it,” Mary Beth Donahue, president and CEO of Better Medicare Alliance, said in a statement.