OIG Finds Humana and UnitedHealth MA Plans Generated $180M in Upcoding Overpayments

HHS OIG audits released September 17, 2026 found that HumanaChoice and UnitedHealthcare of Wisconsin overstated member health conditions in Medicare Advantage risk adjustment submissions, resulting in nearly $180 million in overpayments over a two-year period. The audits concluded both plans frequently exaggerated health needs to inflate capitation payments. OIG has referred the findings to CMS for recovery action. While these audits focus on Medicare Advantage, they signal heightened federal scrutiny of risk adjustment practices that could extend to Medicaid managed care plans using similar diagnosis-driven payment models.

Managed Care