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Medicare Advantage's diagnosing tactics made insurers like UnitedHealthGroup $33 billion richer

Summary by Fortune
Ever since the high-profile murder of UnitedHealthcare CEO Brian Thompson last year, health insurers have faced heavy scrutiny and heightened resentment from the public. Now a new study might fan those flames. That’s because it found that differential coding patterns between Medicare Advantage (MA) and Traditional Medicare (TM) plans led to MA plans receiving an estimated $33 billion in extra revenue—with $13.9 billion, or 42% of the total, goin…

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Study shows how UnitedHealth uses coding to rake in extra cash from Medicare Advantage

Health insurers in the Medicare Advantage business have a big incentive to diagnose their members with lots of health conditions.

·Boston, United States
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FortuneFortune
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Medicare Advantage's diagnosing tactics made insurers like UnitedHealthGroup $33 billion richer

Ever since the high-profile murder of UnitedHealthcare CEO Brian Thompson last year, health insurers have faced heavy scrutiny and heightened resentment from the public. Now a new study might fan those flames. That’s because it found that differential coding patterns between Medicare Advantage (MA) and Traditional Medicare (TM) plans led to MA plans receiving an estimated $33 billion in extra revenue—with $13.9 billion, or 42% of the total, goin…

·New York, United States
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Medical XpressMedical Xpress
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Coding differences in Medicare Advantage plans led to $33 billion in excess revenue to insurers, study finds

An analysis of differential coding patterns between Medicare Advantage (MA) and Traditional Medicare (TM) plans estimated how much coding differs between insurers and how much extra revenue insurers receive as a result.

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NewswiseNewswise

Newswise Latest News: news and press releases in science, medicine, life, and business

An analysis of differential coding patterns between Medicare Advantage (MA) and Traditional Medicare (TM) plans estimated how much coding differs between insurers and how much extra revenue insurers receive as a result.

·Charlottesville, United States
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ajmc.comajmc.com

Differential Coding Inflated Medicare Advantage Payments by $33 Billion in 2021, Study Finds

In 2021, UnitedHealth Group received 42% of the $33 billion in additional Medicare Advantage payments from differential coding.

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ramaonhealthcare.comramaonhealthcare.com

CMS tables GLP-1, AI prior auth policies in Medicare Advantage final rule: 14 things to know – RamaOnHealthcare

CMS has published its final rule for Medicare Advantage and Part D in 2026, outlining a series of regulatory updates aimed at strengthening consumer

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Medical Xpress broke the news in on Monday, April 7, 2025.
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