Senate Report Exposes Medicare Advantage Gaming
Sen. Chuck Grassley (R-Iowa), chair of the Senate Judiciary Committee, released a majority staff report on UnitedHealth Group’s (UHG) efforts to maximize Medicare Advantage (MA) profits by “turning risk adjustment into its own business and siphoning off taxpayer money in breach of the program’s original intent.”
The nation’s largest Medicare Advantage Organization (MAO), UHG has been under scrutiny in recent years. In 2024, investigative activity and reporting—namely, from the Department of Health and Human Services Office of the Inspector General (HHS OIG), The Wall Street Journal, and STAT News—revealed apparent UHG coding abuses, spurring Sen. Grassley to request details from the insurer about their billing practices.
In response, UHG provided Sen. Grassley with over 50,000 pages of documents, including internal training materials, policies, software documentation, and audit tools. Staff review of those records found that “UHG has turned risk adjustment into a major profit centered strategy.” The report out this week describes how the company uses “aggressive strategies” to maximize risk adjustment scores and capture “higher payments from the Centers for Medicare and Medicaid Services (CMS) than any of its peers.” It explains that “UHG appears to be able to leverage its size, degree of vertical integration, and data analytic capabilities to stay ahead of CMS’s efforts to counteract unnecessary spending related to coding intensity.”
MA Payments and Coding Abuses
The Centers for Medicare & Medicaid Services (CMS) pays Medicare Advantage (MA) plans a set amount for each enrollee, increasing payments for sicker enrollees. This is called risk adjustment, and it is an important guardrail to ensure that all people with Medicare have access to MA plans; without it, plans would have reasons to avoid covering people in worse health.
https://www.medicarerights.org/medicare-watch/2026/01/15/senate-report-exposes-medicare-advantage-gaming
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