We have really got this thing figured out. And by we, I mean not you:
Coding differences in Medicare Advantage plans led to $33 billion in excess revenue to insurers
Apr 2025, phys.org
The analysis found that because of coding differences, the average Medicare Advantage risk score in 2021 was 0.19 higher than the average Traditional Medicare risk score and Medicare Advantage plans received an estimated $33 billion in additional revenue, with $13.9 billion, or 42% of the total, going to UnitedHealth Group.MA plans are paid more for sicker members and less for healthier members, providing an incentive for MA plans to report as many diagnoses as legitimately possible.
("As many diagnoses as possible")
The researchers found that the average MA risk score was 18.5% higher than the average TM risk score.Differential coding resulted in an estimated $33 billion in additional payments to MA plans in 2021, a $1,863 increase in revenue per UnitedHealth member, and substantially greater than the industry average of $1,220.Data came from Centers for Medicare and Medicaid Services Chronic Conditions Data Warehouse from 2015 to 2020 and the Master Beneficiary Summary Files from 2015 to 2021. The core analytic sample included 697 contracts that were active in 2021.
via Herbert Wertheim School of Public Health, University of California San Diego, and Actuarial Research Corporation: More information: Insurer-Level Estimates of Revenue From Differential Coding in Medicare Advantage, Annals of Internal Medicine (2025). DOI: 10.7326/ANNALS-24-01345
Read further, the editorial: www.acpjournals.org/doi/10.7326/ANNALS-25-00549