Health insurers must now prove their risk models are accurate, or lose money

The US Health and Human Services Department is tightening rules for how health insurers calculate risk. This means insurers will face stricter audits on their patient data and could lose money if their numbers are wrong.

For years, health insurers have used complex models to predict patient costs, which affects how much they get paid by the government. These new rules make it harder for insurers to game the system by overstating patient risk. It shifts the burden of proof onto the insurers to show their data is accurate, rather than simply submitting it.