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

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Source: STAT News

Original: https://www.statnews.com/2026/01/12/unitedhealth-medicare-advantage-coding-profi...

Published: Mon, 12 Jan 2026 18:52:12 +0000

The Senate report states that UnitedHealth changed the coding in the Medicare Advantage program to a profit-oriented strategy.[1] The probe began after reports by STAT and other media outlets about UnitedHealth's profit-boosting practices in the program.[1] Insurance companies in Medicare Advantage have an incentive to diagnose members with multiple medical conditions because the government pays them more money to do so.[1] The study shows that UnitedHealth excels in obtaining additional payments through coding, with insurers receiving an estimated $33 billion in extra diagnoses in 2021.[1] According to Senator Grassley, UnitedHealth used home health risk assessments and chart reviews for diagnoses that generated revenue, resulting in $8.7 billion in extra payments in 2021.[3] The Senate report also scrutinizes UnitedHealthcare, Humana, and CVS, which account for 59% of all enrollees in 2024, for their high preauthorization denial rates for post-acute care.[2][4][5] The documents revealed that these insurance companies purposefully use preauthorization to increase profits by denying stays in facilities such as nursing homes or rehabilitation clinics.[4][5][7]