Healthcare Finance News September 8, 2025
Simplify HCC coding to prevent “gaming” of system, says Alliance of Community Health Plans.
The Alliance of Community Health Plans is calling out risk adjustment scores by larger insurers in Medicare Advantage plans.
ACHP, an organization that advocates for smaller health plans, said the current model presents many opportunities to “game” the system, according to a published report.
From 2019 to 2023, the average MA risk score by UnitedHealthcare was 36.2% higher than that of ACHP member plans, the report said. Humana’s risk scores were 19.2% higher.
These costs are passed on to Medicare consumers and taxpayers, ACHP said.
ACHP recommends simplifying risk adjustment to focus on demographics and a small set of Hierarchical Condition Category codes to reflect true...
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