There is no question that medical insurance providers are out to get the most bang for their buck, profiting off of patients whenever they can. Now a study confirms the misuse of medical coding to rob patients of financial assets.
A new study published in the Annals of Internal Medicine reveals that major players in the private Medicare space, mainly UnitedHealth Group, have been aggressively over diagnosing their members to make them seem sicker to receive more government funding. They are using medical coding gimmicks to carry out their scheme.
In 2021 alone, their coding manipulation tactic helped Medicare Advantage insurers receive an estimated $33 billion in additional payments from the government, with nearly 42 percent of the total going to just one company: UnitedHealth. Humana and Aetna received much smaller shares: 19 percent and six percent, respectively. It is important to note here that also in 2021, UnitedHealth covered more members than anyone else: 7.5 million people or 27 percent of all members in the program.
The diagnoses these providers frequently over-diagnose include vascular disease, major depressive disorder, and drug and alcohol dependence – conditions common among older adults and more open to interpretation by the medical community as to whether the patient suffers from them or not.
To stop this unethical activity by providers, the Biden administration made changes designed to weed out the most abused diagnosis codes, scheduled to finally take full effect in 2026. More recently, Mehmet Oz, who was confirmed as the new head of the Centers for Medicare and Medicaid Services, pledged to crack down on the abuse of diagnosis codes in Medicare Advantage.
Solidarity HealthShare has extensive experience in medical coding, particularly in reviewing and vetting all codes to ensure they comply with our commitment of ethics and affordability. With our expertise, we advocate for a healthcare model that puts ethics, transparency, and human dignity first, from conception until natural death.
At Solidarity, we ask the Trump administration and Administrator Oz to continue their commitment to healthcare transparency and take swift action on behalf of all American patients. Our current healthcare system is deeply flawed, putting excessive financial strain on families. It is our deep belief that healthcare companies should seek to prioritize the health and well being of their patients as opposed to seeking additional revenue for themselves.
To learn more about our model for affordable, accessible healthcare, give us a call at 737-SHARING.
Sources:
Stat News, “Study shows how United Health uses Coding in Extra Cash from Medicare Advantage,” April 7, 2025, https://www.statnews.com/2025/04/07/medicare-advantage-study-risk-adjustment-coding-unitedhealth/
