Medicare Advantage

Medicare Advantage continues to face a margin-and-compliance reset: federal enforcement this week included a $22.5M False Claims Act settlement with Independence Blue Cross over alleged MA risk-adjustment diagnosis inflation, while HHS OIG separately advanced audits of specific diagnosis codes submitted by UnitedHealthcare Benefits of Texas—reinforcing that risk coding, chart review, and encounter-data governance remain high-risk areas for plans and delegated VBC provider groups. At the same time, large carriers are retrenching 2027 MA offerings—UnitedHealth plan exits affecting roughly 390,000 members and broader benefit cuts to dental allowances and premium givebacks signal tighter economics, with plans prioritizing margin recovery over supplemental-benefit richness. For ACOs, health systems, and risk-bearing medical groups, the near-term dynamic is clear: expect more disruption in MA network strategy and member continuity, alongside heightened scrutiny of documentation practices tied to revenue integrity and downside risk arrangements (DOJ settlement; OIG MA audit).