Medicare Advantage Stars

Medicare Advantage risk adjustment scrutiny intensified as Complete Health agreed to pay $14.1M to resolve DOJ allegations that it submitted unsupported diagnosis codes to CMS, reinforcing compliance risk for VBC-aligned primary care groups and MA plans relying on coding-driven revenue in capitated arrangements (Healthcare Dive). At the same time, NCQA approved person-centered outcome measures for HEDIS MY 2027 for D-SNPs and C-SNPs, signaling that Stars-adjacent quality strategy will keep shifting from process documentation toward beneficiary goal attainment and care-plan outcomes—especially for high-need populations (NCQA). UnitedHealthcare’s reported consideration of additional MA market exits adds pressure to the Stars/payment equation, as plans reassess county footprints amid margin compression, risk adjustment enforcement, and quality-bonus volatility.