ELV · 10-Q · 2026Q2 · Full report

Medicare Advantage Risk Adjustment Contingency

Elevance Health, Inc. · 2026-07-15 · Importance 59 · Surprise 60 · In source text

The Company recorded a loss contingency accrual in the six months ended June 30, 2026 for the best estimate of identified potential exposure related to the resubmission of certain historical Medicare Advantage risk adjustment data; this accrual was a primary driver of the decrease in net income for the six months ended June 30, 2026. The accrual materially increased operating expense and unallocated corporate expenses in the Corporate & Other segment and was cited as a principal cause of the six-month decline in shareholders’ net income. Separately, the Company also disclosed that on July 13, 2026 CMS stated the Company completed required steps and that sanctions will not be imposed and the enforcement process for this matter has been closed.

Key facts

• In connection with the notice the Company received in February 2026 from CMS regarding certain Medicare Advantage risk adjustment data submission requirements related to diagnosis codes for dates of service 2015 through April 2023, CMS provided a series of steps required to be completed by July 31, 2026 in order to avoid sanctions. source
• On July 13, 2026, the Company received a letter from CMS stating that the Company has completed all required steps, sanctions will not be imposed and the enforcement process for this matter has been closed. source
• The decrease in total shareholders' net income for the six months ended June 30, 2026 was primarily due to the loss contingency accrual for our best estimate of the identified potential exposure for the resubmission of certain historical Medicare Advantage risk adjustment data within our Corporate & Other segment. source

Impact estimates