Elevance Had to Give $342 Million Back to Taxpayers

The payment to CMS is the latest sign of mounting scrutiny over Medicare Advantage billing practices.

Elevance Health, one of the nation’s biggest health insurance conglomerates, wired more than $342 million to the Centers for Medicare & Medicaid Services a few weeks ago after the agency threatened to suspend enrollment in the company’s Medicare Advantage plans over what CMS described as years of “substantial and persistent noncompliance” with federal billing requirements.

The payment represents only part of what the company itself has estimated it may ultimately owe the government, which is closer to $1 billion.

As I wrote in April, Elevance knew that it was billing Medicare improperly but kept doing it anyway. Inside the company’s Q1 2026 earnings release, Elevance disclosed that it had set aside funds to cover its potential liability after CMS concluded the company failed for years to properly correct unsupported diagnosis codes that directly affect how much Medicare pays private insurers.

According to CMS, Elevance repeatedly declined to use the agency’s required electronic reporting systems, instead submitting corrections through encrypted flash drives despite repeated warnings from regulators.

The company disputes the government’s interpretation of the rules and has denied wrongdoing. But companies don’t voluntarily wire more than $342 million to the federal government for no reason.

Several federal audits, whistleblower lawsuits and independent researchers have concluded that Medicare Advantage plans have received billions of dollars in excess payments through inflated risk scores and unsupported diagnoses.

Just last month, the HHS Office of Inspector General found Medicare Advantage insurers likely received $462 million in improper payments for stroke diagnoses that patients’ medical records did not support. As much as that is, it’s just the tip of the iceberg. Improper payments to private MA insurers will exceed a trillion dollars over the next ten years according to government watch dogs unless Congress acts to stop them. The Medicare Payment Advisory Commission (MedPAC) estimates that the government will overpay Medicare Advantage plans by $76 billion this year alone. That’s our tax dollars we’re talking about.