Medicare Advantage Enrollment Manipulation Schemes

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' well-being at risk. To date, enrollment manipulation schemes have been identified primarily 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.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
September 2025	CMS	Medicare Advantage Enrollment Manipulation Schemes	Office of Evaluation and Inspection	OEI-BL-25-00380	2027