UHC MA Shenanigans, Profit Falls at BCBS Minnesota, Senate Introduces Pharmacy Bill

Hey all,

Happy Tuesday! Reading the new study on UnitedHealth’s upcoding efforts shows another negative effect of vertical integration. If they didn’t employ 10% of the MDs in the US these types of shenanigans would be much harder for them to execute. Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(STAT) Medicare Advantage Risk Adjustment Study

A new study in the Annals of Internal Medicine reveals UnitedHealth Group pocketed nearly $14 billion in 2021—42% of the $33 billion in excess government payments—by aggressively coding its Medicare Advantage members as sicker than they likely were, using tactics like chart reviews and in-home assessments. While the study offers hard numbers, the headline basically writes itself—UnitedHealth is the frontrunner in gaming the system, shocking absolutely no one except maybe the interns on their first day. With the “new sheriff in town” at CMS, the pressure is on to fix the rigged system. Full Article

(Star Tribune) Minnesota BCBS Parent Company’s Profit Drop

Operating income for Aware Integrated, the parent company of Blue Cross and Blue Shield of Minnesota, fell 73% in 2024 to $27.6 million due to historically high levels of health care utilization. While commercial coverage saw profit gains, these were outweighed by losses in Medicare Advantage and Medicaid plans, which faced higher claims and lower membership. The results reflect a broader industry trend as health insurers move away from the unusually high earnings experienced during the COVID-19 era. Full Article.

(BenefitsPro) FTC Prescription Drug Market Report

The Senate Judiciary Committee has unanimously advanced the Prescription Pricing for the People Act of 2025, which mandates that the Federal Trade Commission complete its long-delayed report on competition within the prescription drug supply chain. This move highlights growing bipartisan concern over the influence of pharmacy benefit managers (PBMs) and intermediaries on drug pricing and calls for actionable recommendations to boost transparency and affordability. The bill reflects a broader federal push toward antitrust enforcement in health care, signaling potential shifts in how pharmaceutical costs are regulated. Full Article