Medicare Advantage Enrollment Manipulation Schemes

OBJECTIVE

The Medicare Advantage program is vulnerable to schemes designed to increase Medicare Advantage organization (MAO) profits by improperly influencing enrollment. Known examples of such schemes include enrolling people into MA plans without their consent, structuring incentive payments to agents to minimize enrollment of people with disabilities, and paying kickbacks to providers in exchange for enrollments. These schemes put taxpayer dollars and Medicare enrollees’ wellbeing at risk. To date, enrollment manipulation schemes have primarily been identified through whistleblowers, with minimal visibility into schemes that go unreported. To address this gap, we will conduct a large-scale analysis of enrollment and disenrollment data to identify aberrant patterns that may signal improper MAO actions to influence enrollment.

TIMELINE

• September 15, 2025
  Announced
• Today
  Office of Evaluation and Inspections In-Progress
• Est FY2027
  Estimated Fiscal Year for Project Completion

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