CAP Calls on CMS To Hold Medicare Advantage Plans Accountable for Upcoding, Predatory Marketing, Prior Authorization Practices, and AI Use in Coverage Decisions

The Center for American Progress submitted comments to the Centers for Medicare and Medicaid Services (CMS) urging reforms to rein in Medicare Advantage overpayments, strengthen accountability for providing equitable care, and protect beneficiaries from predatory marketing practices and prior authorization-related harms.

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Medicare Advantage now covers more than half of all Medicare beneficiaries, yet significant problems persist: Plans receive tens of billions in excess payments driven by aggressive diagnostic coding, beneficiaries face care delays and denials from prior authorization practices, and misleading marketing continues to steer enrollees into plans that may not meet their needs. CMS’ contract year 2027 proposed rule presents an opportunity to address these challenges.

In a comment letter submitted on January 26, 2026, the Center for American Progress urges CMS to reform risk adjustment to curb overpayments, hold plans accountable for prior authorization harms, establish oversight of artificial intelligence (AI) in coverage decisions, and maintain marketing protections and health equity standards. These steps would move Medicare Advantage closer to what it should be: a program that improves care and lowers costs, rather than one that enriches plans at the expense of both.

Click here to read CAP’s comment letter.

The positions of American Progress, and our policy experts, are independent, and the findings and conclusions presented are those of American Progress alone. American Progress would like to acknowledge the many generous supporters who make our work possible.

Author

Neda Ashtari

Associate Director, Health Policy

Department

Health Policy

The Health Policy department advances health coverage, health care access and affordability, public health and equity, social determinants of health, and quality and efficiency in health care payment and delivery.