ArticleThe journal of political economy2020
Upcoding: Evidence from Medicare on Squishy Risk Adjustment.
Article in The journal of political economy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 109 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
109 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Value-Based Provider Payment Initiatives Combining Global Payments With Explicit Quality Incentives: A Systematic Review.Medical care research and review : MCRR · 2020Pooled it
- Financial Effects of an Out-of-Pocket Cap in Traditional Medicare.JAMA health forum · 2026Article
- Clinical and Economic Burden of Obesity and Cardiovascular Disease Among Medicare Fee-For-Service Beneficiaries.Diabetes, obesity & metabolism · 2026Article
- Does Medicare Advantage funding disparity affect managed care insurers' profitability? Evidence from Puerto Rico.Health affairs scholar · 2026Article
- Streamlining oversight in Medicare advantage: measuring coding intensity via contract rankings.Health affairs scholar · 2026Article
- Does Provincial Pooling of the Resident Medical Insurance Fund Improve the Efficiency of Medical Resource Allocation of China?Healthcare (Basel, Switzerland) · 2026Article
- Association between integrated specialty pharmacy care model and pharmaceutical access and costs.Health affairs scholar · 2026Article
- Heterogeneous responses to risk-adjustment reform: evidence from dementia diagnosis in Medicare Advantage.Health affairs scholar · 2026Article
- Who owns your doctor? A decade of trends in physician practice ownership in dermatology and gastroenterology.Health affairs scholar · 2026Article
- Cross-sectional analysis of accuracy versus interpretability in Medicare Advantage risk adjustment.Health policy OPEN · 2026Article
- Exposure to the new Medicare Advantage risk adjustment model varies across insurers.Health affairs scholar · 2026Article
- Hospital-Medicare Advantage vertical integration and medical loss ratios.Health affairs scholar · 2026Article
- A Simple Primer on Relative Value Units for Surgeons.Plastic and reconstructive surgery. Global open · 2026Article
- Risk Adjustment for Alzheimer Disease and Related Dementias in Medicare Advantage and Health Care Experiences.JAMA network open · 2026Article
- Differences in the Measurement of Comorbidities Based on ICD-10-CM Coding Definitions Using Medicare Advantage Encounter Data and Fee-For-Service Claims.Medical care · 2026Article
- Accountable Care Organization Efficiency on Entry and Shared Savings Bonuses.JAMA network open · 2026Article
- The importance and challenge of comparing stroke care, utilization and outcomes in Medicare Advantage and Fee-for-Service Medicare: a narrative review and vision for the future.Journal of comparative effectiveness research · 2026Review
- Hospital-Medicare Advantage Vertical Integration and Cardiopulmonary Care in Integrated Hospitals.JAMA health forum · 2025Article
- Cardiovascular Risk Factor Management in Medicare Advantage and Traditional Medicare.Circulation. Cardiovascular quality and outcomes · 2025Article
- Identifying Coding Intensity in Medicare Advantage Through Switchers.Health services research · 2025Article
49 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
Abstract
In most US health insurance markets, plans face strong incentives to "upcode" the patient diagnoses they report to the regulator, as these affect the risk-adjusted payments plans receive. We show that enrollees in private Medicare plans generate 6% to 16% higher diagnosis-based risk scores than they would under fee-for-service Medicare, where diagnoses do not affect most provider payments. Our estimates imply that upcoding generates billions in excess public spending and significant distortions to firm and consumer behavior. We show that coding intensity increases with vertical integration, suggesting a principal-agent problem faced by insurers, who desire more intense coding from the providers with whom they contract.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.