ANALYSIS: Efforts to Rein in Upcoding in MA Plans Gain Steam

Upcoding in Medicare Advantage (MA) plans has recently been targeted by both Congress and the executive branch, suggesting that the ongoing crackdown on the insurance practice is growing more varied and intense.

In addition to a renewed push by members of Congress to pass the No UPCODE Act, new regulations have been proposed by the Centers for Medicare & Medicaid Services, and recent settlements of MA fraud cases have cost insurers hundreds of millions of dollars.

Even if the No UPCODE Act doesn’t pass, increased enforcement and more stringent rules could impact the operations of MA insurers. If they ...