This is the best explanation that I have seen for the coding discrepancies. It is from the TVH's bankruptcy filing.
TVH receives a monthly payment per member (“PMPM”) for each MA beneficiary that it treats. The PMPM amount that Centers for Medicare and Medicaid Services (CMS) pays MA plans depend on a number of risk adjustments factors (“RAF Scores”) that are meant to reflect the illness level of patients. Generally speaking, MA plans receive higher PMPM payments for patients who have higher RAF Scores and are anticipated to have higher medical expenses than patients with lower RAF Scores. Hierarchical Condition Categories (“HCC”) codes are a significant input in the calculation of RAF Scores. Through its contracts with MA plans, TVH generally receives larger payments for beneficiaries with higher RAF Scores.
I thought that the insurance companies receive larger payments - not the TVH.
Article on Risk Adjustment Factor (RAF) score fraud.
Understanding Risk Adjustment Factor (RAF) Score Fraud and How to Get a Reward for Reporting It - Daniel J. Ocasio Whistleblower Law Group