The Big Story 

The senior interest group is putting its backing behind bipartisan legislation aimed at preventing the practice of upcoding in Medicare Advantage, when healthcare providers bill for inaccurate codes to increase their reimbursement. 

© Greg Nash

In a statement Thursday, AARP noted that upcoding is expected to increase care costs for Medicare Advantage enrollees by $40 billion this year. 

The No UPCODE Act was introduced by Sens. Bill Cassidy (R-La.) and Jeff Merkley (D-Ore.) earlier this year. The bill would disincentivize upcoding by developing a risk-adjustment model using two years of diagnostic data as opposed to one, limiting the use of unrelated medical conditions when estimating the cost of care, and bridging the gap between how patients on Medicare Advantage and traditional Medicare are assessed. 

In a letter to Cassidy and Merkley, AARP senior vice president for government affairs Bill Sweeney wrote, “While many Medicare beneficiaries appreciate the flexibility and ease of use that MA provides, we are concerned that upcoding leads to both inflated payments to insurance plans and higher premiums for American seniors.” 

“These resources would be better spent strengthening Medicare, such as by providing dental, hearing, and vision coverage,” Sweeney added. 

“This bill addresses a problem both Republicans and Democrats have labeled as waste, fraud, and abuse. AARP agrees the No UPCODE Act protects seniors by preserving benefits and eliminating waste,” Cassidy said in a statement Thursday. “When companies upcode, taxpayers foot the bill and patients get nothing. That’s wrong.” 

While the Trump administration has railed against waste, fraud and abuse in Medicare and Medicaid, the vast majority of Medicare payments are made properly. 

As KFF found in its analysis of fiscal year 2024 payments, 94.4 percent of Medicare Advantage payments were made properly, with improper Medicare payments totaling $54.3 billion. 

Welcome to The Hill’s Health Care newsletter, we’re Nathaniel Weixel, Joseph Choi and Alejandra O’Connell-Domenech — every week we follow the latest moves on how Washington impacts your health.

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