Corporate Practice of Medicine: Vertical Alignment and Medicare Advantage Risk CodingarticlesA long-appreciated, but understudied, aspect of vertical integration is the ability to align incentives and enable coordination between principals and agents. We examine this dynamic in the context of vertical alignment between physicians and corporate primary care practices (CPCPs), which are often integrated with Medicare Advantage (MA) insurers. While concerns of increased coding intensity in MA are well-documented, the mechanisms that enable aggressive coding are less clear. Using hand-collected data on physician employment by CPCPs and national MA encounter data, we find that switching employment to a CPCP leads to an approximately 25% increase in MA risk score payments after 2 years and a 35% increase by 5 years. We find no evidence of increased health care utilization or an alternative risk score that uses pharmaceutical claims rather than recorded medical diagnoses. The increase in risk scores is driven by low-acuity and discretionary diagnoses. We estimate that higher risk-score payments due to integration lead to a $1.6 billion increase in annual payments from taxpayers to MA insurers.David J. MeyersAuthorJay ShroffAuthorYashaswini SinghAuthorChristopher WhaleyAuthor2025Medicare Advantagerisk score paymentsprincipal-agent relationshipshealth care provider consolidationWorking PaperAll rights reservedIn CopyrightAll Rights Reserved10.26300/amm6-vh76