Specifically, MA plans were found to have higher risk scores, leading to increased payments, with UnitedHealth Group receiving a substantial portion of these overpayments.
The research analyzed data from nearly 700 Medicare Advantage contracts across about 200 insurers. It focused on the impact of coding intensity on risk scores and subsequent payments to MA plans.
The study found that MA plans, on average, coded patient diagnoses more intensely than traditional Medicare (TM), resulting in higher risk scores. This means MA plans were assigning more diagnoses to patients, making them appear sicker and qualifying them for higher reimbursements.
UnitedHealth Group, a major player in the MA market, received a significant portion of these overpayments – approximately $13.9 billion, or 42% of the total.
Kronick, R., Chua, F. M., Krauss, R., Johnson, L., & Waldo, D. (2025). Insurer-Level estimates of revenue from differential coding in Medicare advantage. Annals of Internal Medicine. https://doi.org/10.7326/annals-24-01345
Bannow, T. (2025, April 8). Study shows how UnitedHealth uses coding to rake in extra cash from Medicare Advantage. STAT. https://www.statnews.com/2025/04/07/medicare-advantage-study-risk-adjustment-coding-unitedhealth/
Berryman, L. (2025, April 8). UnitedHealth, Humana made billions from Medicare Advantage coding. Modern Healthcare. https://www.modernhealthcare.com/insurance/unitedhealth-humana-medicare-advantage-coding/
Greenfield, B. (2025, April 9). Medicare Advantage’s diagnosing tactics made insurers like UnitedHealthGroup $33 billion richer. Fortune Well. https://fortune.com/well/2025/04/07/medicare-advantage-diagnosing-tactics-insurers-unitedhealthgroup-33-billion-richer/
Berger, L. (2025, April 10). Study: UnitedHealthcare generated $14B in MA overpayments through upcoding in 2021. McKnights Home Care. https://www.mcknightshomecare.com/news/study-unitedhealthcare-generated-14b-in-ma-overpayments-through-upcoding-in-2021/
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