Senate Report Finds UnitedHealth Turned Medicare Advantage Risk Adjustment into a Profit Strategy

Grassley Report Details UnitedHealth’s Record of Appearing to Game the Medicare Advantage System, Turning Risk Adjustment into Its Own Business

“Bloated federal spending to UnitedHealth Group is not only hurting the Medicare Advantage program, it’s harming the American taxpayer.”
— U.S. Senate, Senator Chuck Grassley, January 12, 2026

UnitedHealth Manipulates Risk Adjustment Process to Game MA, Senator’s Report Finds

“UnitedHealth used certain resources and strategies to capture a higher number of diagnoses and diagnosis codes — known as upcoding — resulting in higher payments from the Centers for Medicare and Medicaid Services. ‘My investigation has shown UnitedHealth Group appears to be gaming the system and abusing the risk adjustment process to turn a steep profit. Taxpayers and patients deserve accurate, clear-cut and fair risk adjustment processes,’ Grassley said.”
— McKnight’s Home Care, January 13, 2026

UnitedHealth ‘Aggressively’ Gaming Medicare Advantage, Senate Investigation Finds

“UnitedHealth has ‘turned risk adjustment into a major profit centered strategy, which was not the original intent,’ the new report from Sen. Chuck Grassley, R-Iowa, says… UnitedHealth pays external providers to assess patients for certain diseases, and many physicians code through diagnosis workflows controlled by the company, according to the report. This workforce is backed by sweeping data and technology assets and expertise that allows UnitedHealth to identify untapped opportunities to further inflate risk scores.”
— Healthcare Dive, January 12, 2026

Senate finds UnitedHealth used ‘aggressive strategies’ in Medicare Advantage

While the report does not make recommendations or accuse UnitedHealth of misconduct, it does point out how nurses collected diagnoses at patient homes, doctors received bonuses for weighing other diagnoses and AI was used to search for new diagnoses in patient records.

“Bloated federal spending to UnitedHealth Group is not only hurting the Medicare Advantage program, it’s harming the American taxpayer,” Mr. Grassley said in a news release.

Examples of concerning diagnoses included atrial fibrillation, chronic obstructive pulmonary disease, diabetic cataracts and opioid dependence. UnitedHealth had nurse practitioners visiting patient homes in its HouseCalls program to test patients for peripheral artery disease using the QuantaFlo device.

— Becker’s, January 12, 2026

UnitedHealth Has Turned Medicare Advantage Coding into ‘Profit-Centered Strategy,’ Senate Report Finds

“UnitedHealth, which serves 10 million Medicare Advantage members, has converted risk adjustment into ‘a major profit-centered strategy, which was not the original intent’ of the program. The company allegedly pushed these tactics ‘to the utmost degree.'”
— STAT News, January 12, 2026