Excerpt from this site (well worth a read). https://healthcareuncovered.substack.com/p/flash-drives-and-funny-numbers-what
“buried inside the same earnings release was a $935 million charge — the company’s “best estimate” of what it may owe the federal government for years of improper Medicare Advantage billing.”
Based on “February 27 notice from the Centers for Medicare & Medicaid Services:
Medicare Advantage insurers are paid by the government based on the health status of their members. Sicker patients generate higher “risk scores,” which generate higher payments. Insurers are required to submit accurate diagnosis data to CMS through its electronic systems — and if they discover that a diagnosis code isn’t supported by medical records, they’re required to correct it and return any overpayment within 60 days.
Elevance didn’t do that. According to CMS, from November 2018 through October 2025, the company submitted data corrections for unsupported diagnosis codes not through the required electronic systems but via encrypted external USB flash drives — a method CMS had explicitly rejected. During that same period, the company sent CMS seven letters stating it did not intend to use the required systems. CMS sent six letters directing it to comply.
The agency’s language was unambiguous: Elevance’s conduct represents “substantial and persistent noncompliance” that “has persisted for over seven years despite repeated clear directives from CMS.”
The result, as CMS sees it: Elevance collected government overpayments it never returned, and repeatedly certified the accuracy of its data submissions while knowing that unverified diagnosis codes had not been corrected through the required channels.”
“That is not a paperwork problem. That is a description of a company that — for seven years, across multiple administrations — chose to do things its own way with Medicare’s money.”