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STAT+: 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.
Health insurers in the private Medicare business have a big incentive to diagnose their members with lots of health conditions: The government pays them more money.
A new study shows the extent to which the biggest player in that business, UnitedHealth Group, stands out from the rest for its prowess at raking in extra cash from that program.
Medicare Advantage insurers pulled in an estimated $33 billion in additional payment from the government in 2021 as a result of these extra diagnoses, or codes, that made their members seem sicker, relative to people in the traditional Medicare program. Almost $14 billion of that, or 42%, went to a single company: UnitedHealth, according to the research, published Monday in the Annals of Internal Medicine. Other insurers, like Humana and Aetna, comprised much smaller shares: 19% and 6%, respectively.
