Medicare Advantage Stars

Medicare Advantage risk adjustment and Stars-adjacent quality strategy are facing a sharper compliance-and-measurement squeeze: Complete Health agreed to pay $14.1 million to settle DOJ allegations that it submitted unsupported diagnosis codes to CMS, reinforcing that MA coding intensity remains an enforcement priority for plans, delegated risk groups, and VBC primary care platforms (Healthcare Dive). At the same time, NCQA’s HEDIS MY 2027 updates—especially new person-centered outcome measures for D-SNPs and C-SNPs—signal continued migration away from process-heavy Stars tactics toward member-reported goals, care planning, and outcomes, raising operational stakes for MA plans, SNP operators, and provider groups managing complex populations (NCQA). Together, the week’s developments point to a tighter MA VBC environment under CMS: less tolerance for revenue capture without documentation, and more pressure to prove measurable, person-centered value in high-need populations.