Healthcare DIVE January 27, 2026
If finalized, the proposal would eliminate the financial motivation insurers have to mine their members’ charts for additional diagnoses, disproportionately affecting UnitedHealthcare.
The Trump administration has taken a big step toward curbing Medicare Advantage overpayments, proposing a rule that would stamp out one strategy insurers use to inflate their members’ sicknesses to get higher reimbursement in the privatized Medicare program.
In a rule released Monday, the CMS proposed excluding patient diagnoses that aren’t linked to actual medical care from MA risk adjustment.
The policy would eliminate the financial motivation insurers have to mine their members’ medical charts for additional diagnoses, since insurers wouldn’t be able to use those additional diagnoses to inflate members’ risk scores.
CMS actuaries predict the change...
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