STAT+: UnitedHealth has turned Medicare Advantage coding into ‘profit-centered strategy,’ Senate report finds

UnitedHealth Group’s colossal size has helped the conglomerate turn the way patients are coded in the Medicare Advantage program into “a major profit-centered strategy, which was not the original intent of the program,” according to a new report released Monday from the Senate Judiciary Committee.

The 105-page report, based on 50,000 pages of documents submitted by UnitedHealth to Sen. Chuck Grassley (R-Iowa), focuses on an insurance practice called risk adjustment, in which health insurers are paid more to cover sicker members. UnitedHealth, the top seller of Medicare Advantage plans with 10 million members, has pushed risk adjustment tactics “to the utmost degree,” the report said.

Grassley, who chairs the Senate committee, requested information from UnitedHealth in February after STAT and the Wall Street Journal reported on the different ways UnitedHealth codes the diagnoses of its Medicare Advantage members. His report cites STAT’s coverage of this issue. 

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