diff --git a/domains/health/CMS 2027 chart review exclusion targets vertical integration profit arbitrage by removing upcoded diagnoses from MA risk scoring.md b/domains/health/CMS 2027 chart review exclusion targets vertical integration profit arbitrage by removing upcoded diagnoses from MA risk scoring.md
index 63b8ff9d1..757a03f06 100644
--- a/domains/health/CMS 2027 chart review exclusion targets vertical integration profit arbitrage by removing upcoded diagnoses from MA risk scoring.md	
+++ b/domains/health/CMS 2027 chart review exclusion targets vertical integration profit arbitrage by removing upcoded diagnoses from MA risk scoring.md	
@@ -34,6 +34,12 @@ The broader 2027 rate environment compounds the pressure into a three-pronged sq
 
 This is a proxy inertia story. Since [[proxy inertia is the most reliable predictor of incumbent failure because current profitability rationally discourages pursuit of viable futures]], the incumbents who built their MA economics around coding optimization will struggle to shift toward genuine quality competition. The plans that never relied on coding arbitrage (Devoted, Alignment, Kaiser) are better positioned.
 
+
+### Additional Evidence (extend)
+*Source: [[2025-03-26-crfb-ma-overpaid-1-2-trillion]] | Added: 2026-03-12 | Extractor: anthropic/claude-sonnet-4.5*
+
+(extend) CRFB analysis shows coding intensity accounts for $600B of the $1.2T MA overpayment total (2025-2034), with $260B hitting the Medicare Trust Fund and $110B increasing beneficiary premiums. Even after CMS's current 5.9% coding adjustment, MA plans see a 10% net payment increase from coding practices. Raising the minimum coding adjustment from 5.9% to 20% could reduce deficits by over $1 trillion, providing fiscal context for why CMS is pursuing the 2027 chart review exclusion. The scale of coding-driven overpayment makes this a Medicare solvency issue, not just a payment accuracy concern.
+
 ---
 
 Relevant Notes:
diff --git a/domains/health/favorable-selection-in-medicare-advantage-is-structural-not-fraudulent-because-plan-design-features-discourage-high-utilizers.md b/domains/health/favorable-selection-in-medicare-advantage-is-structural-not-fraudulent-because-plan-design-features-discourage-high-utilizers.md
new file mode 100644
index 000000000..53be2cc7f
--- /dev/null
+++ b/domains/health/favorable-selection-in-medicare-advantage-is-structural-not-fraudulent-because-plan-design-features-discourage-high-utilizers.md
@@ -0,0 +1,41 @@
+---
+type: claim
+domain: health
+description: "Prior authorization and narrow networks create self-selection of healthier beneficiaries into MA without illegal activity"
+confidence: likely
+source: "Committee for a Responsible Federal Budget analysis of MedPAC data, March 2025"
+created: 2026-03-11
+secondary_domains:
+  - grand-strategy
+---
+
+# Favorable selection in Medicare Advantage is structural not fraudulent because plan design features discourage high-utilizers
+
+Medicare Advantage plans achieve $580 billion in overpayments through favorable selection—attracting healthier beneficiaries—without engaging in illegal activity. This selection effect is built into plan design through mechanisms like prior authorization requirements and narrow provider networks that systematically discourage care-seeking behavior.
+
+Unlike coding intensity (which can involve fraudulent upcoding), favorable selection operates through legal plan features that create friction for high-utilizers while remaining attractive to healthier beneficiaries. Prior authorization adds administrative burden to accessing care. Narrow networks limit provider choice, which matters more to people with established specialist relationships (typically sicker patients). These features cause healthier people to self-select into MA plans.
+
+The result is an 11% cost increase versus fee-for-service Medicare in 2025 from favorable selection alone, contributing $250B to Medicare Trust Fund costs and $110B to beneficiary premiums over the decade. Because this is structural rather than fraudulent, it cannot be addressed through fraud enforcement—it requires payment methodology reform.
+
+## Evidence
+
+- $580B in overpayments from favorable selection 2025-2034 (MedPAC data via CRFB)
+- 11% increased MA costs vs FFS in 2025 from favorable selection
+- Prior authorization and narrow networks identified as selection mechanisms in CRFB analysis
+- Selection effect is legal plan design, not fraudulent activity
+- Magnitude nearly equal to coding intensity ($600B vs $580B), demonstrating structural significance
+
+## Policy Implications
+
+The structural nature of favorable selection means it persists regardless of fraud enforcement. MA plans rationally design features that attract profitable (healthier) members. This creates a fundamental misalignment: plans profit from selection rather than from improving health outcomes. Payment reform must address risk adjustment methodology, not just police coding practices. This distinguishes favorable selection from coding fraud—one is a design choice, the other is a violation.
+
+---
+
+Relevant Notes:
+- value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md
+- CMS 2027 chart review exclusion targets vertical integration profit arbitrage by removing upcoded diagnoses from MA risk scoring.md
+- proxy inertia is the most reliable predictor of incumbent failure because current profitability rationally discourages pursuit of viable futures.md
+
+Topics:
+- domains/health/_map
+- core/grand-strategy/_map
diff --git a/domains/health/medicare-advantage-overpayments-total-1-2-trillion-over-2025-2034-driven-equally-by-coding-intensity-and-favorable-selection.md b/domains/health/medicare-advantage-overpayments-total-1-2-trillion-over-2025-2034-driven-equally-by-coding-intensity-and-favorable-selection.md
new file mode 100644
index 000000000..85c648716
--- /dev/null
+++ b/domains/health/medicare-advantage-overpayments-total-1-2-trillion-over-2025-2034-driven-equally-by-coding-intensity-and-favorable-selection.md
@@ -0,0 +1,45 @@
+---
+type: claim
+domain: health
+description: "MedPAC data shows MA overpayments split evenly between upcoding ($600B) and healthier patient selection ($580B) over 2025-2034"
+confidence: likely
+source: "Committee for a Responsible Federal Budget, Medicare Advantage Will Be Overpaid by $1.2 Trillion (2025-2034), March 2025"
+created: 2026-03-11
+depends_on:
+  - "value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md"
+---
+
+# Medicare Advantage overpayments total $1.2 trillion over 2025-2034 driven equally by coding intensity and favorable selection
+
+Medicare Advantage plans will receive $1.2 trillion in overpayments relative to traditional Medicare between 2025 and 2034, according to MedPAC data analyzed by CRFB. This overpayment is driven by two mechanisms of nearly equal magnitude:
+
+**Coding intensity ($600B):** MA plans document diagnoses more aggressively than traditional Medicare, resulting in higher risk scores and payments. Even after CMS's 5.9% coding adjustment, MA plans see a 10% net payment increase from coding practices. This accounts for $260B in Medicare HI Trust Fund impact and $110B in beneficiary premium costs.
+
+**Favorable selection ($580B):** MA plans attract healthier beneficiaries through plan design features like prior authorization and narrow networks that discourage care-seeking behavior. This structural selection effect causes 11% higher MA costs versus fee-for-service in 2025 from favorable selection alone. This accounts for $250B in Trust Fund impact and $110B in beneficiary premium costs.
+
+The combined fiscal impact includes ~$510B to the Medicare Trust Fund and ~$220B in higher beneficiary premiums. Policy options include reducing payment benchmarks (CBO estimates $489B in savings) or raising the minimum coding adjustment from 5.9% to 20% (over $1 trillion in deficit reduction). Both would substantially extend Medicare trust fund solvency.
+
+## Evidence
+
+- MedPAC data showing $1.2T total overpayment projection 2025-2034
+- Coding intensity creates 10% net payment increase after CMS 5.9% adjustment
+- Favorable selection causes 11% increased MA costs vs FFS in 2025
+- CBO scoring: benchmark reduction saves $489B, coding adjustment increase saves $1T+
+- Combined trust fund impact: $510B over decade
+- Combined beneficiary premium impact: $220B over decade
+
+## Significance
+
+This claim quantifies the fiscal stakes of MA payment reform at a scale that makes it a Medicare solvency issue, not merely a pricing inefficiency. The symmetry between coding intensity and favorable selection is critical: policy debate focuses on upcoding fraud, but favorable selection is almost exactly as large and is structural rather than illegal. MA plans benefit from attracting healthier members through plan design, and there's no fraud to prosecute.
+
+The $1.2T overpayment over a decade represents one of the largest single drivers of Medicare spending growth, occurring as the Medicare Trust Fund faces insolvency acceleration (now projected for 2040). This creates a fiscal collision course where unreformed MA payment structure directly threatens Medicare solvency.
+
+---
+
+Relevant Notes:
+- value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md
+- CMS 2027 chart review exclusion targets vertical integration profit arbitrage by removing upcoded diagnoses from MA risk scoring.md
+- proxy inertia is the most reliable predictor of incumbent failure because current profitability rationally discourages pursuit of viable futures.md
+
+Topics:
+- domains/health/_map
diff --git a/domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md b/domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md
index eb54caa1d..95e36c7c1 100644
--- a/domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md	
+++ b/domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md	
@@ -23,6 +23,12 @@ The Making Care Primary model's termination in June 2025 (after just 12 months,
 
 PACE represents the extreme end of value-based care alignment—100% capitation with full financial risk for a nursing-home-eligible population. The ASPE/HHS evaluation shows that even under complete payment alignment, PACE does not reduce total costs but redistributes them (lower Medicare acute costs in early months, higher Medicaid chronic costs overall). This suggests that the 'payment boundary' stall may not be primarily a problem of insufficient risk-bearing. Rather, the economic case for value-based care may rest on quality/preference improvements rather than cost reduction. PACE's 'stall' is not at the payment boundary—it's at the cost-savings promise. The implication: value-based care may require a different success metric (outcome quality, institutionalization avoidance, mortality reduction) than the current cost-reduction narrative assumes.
 
+
+### Additional Evidence (extend)
+*Source: [[2025-03-26-crfb-ma-overpaid-1-2-trillion]] | Added: 2026-03-12 | Extractor: anthropic/claude-sonnet-4.5*
+
+(extend) CRFB analysis of MedPAC data quantifies the fiscal cost of this payment boundary stall: $1.2 trillion in MA overpayments over 2025-2034, with $510B hitting the Medicare Trust Fund. The overpayment splits evenly between coding intensity ($600B) and favorable selection ($580B). Policy options exist—CBO estimates reducing benchmarks could save $489B, and raising the minimum coding adjustment from 5.9% to 20% could reduce deficits by over $1 trillion—but these reforms face political resistance because MA plans and their beneficiaries are now embedded in the system. The payment boundary creates a $1.2T transfer from taxpayers to MA plans over a decade, demonstrating that partial risk-bearing enables systematic overpayment at scale.
+
 ---
 
 Relevant Notes:
diff --git a/inbox/archive/2025-03-26-crfb-ma-overpaid-1-2-trillion.md b/inbox/archive/2025-03-26-crfb-ma-overpaid-1-2-trillion.md
index 9da2d0bd6..8401b0b0c 100644
--- a/inbox/archive/2025-03-26-crfb-ma-overpaid-1-2-trillion.md
+++ b/inbox/archive/2025-03-26-crfb-ma-overpaid-1-2-trillion.md
@@ -7,9 +7,15 @@ date: 2025-03-26
 domain: health
 secondary_domains: []
 format: report
-status: unprocessed
+status: processed
 priority: high
 tags: [medicare-advantage, overpayment, fiscal-impact, coding-intensity, favorable-selection, trust-fund]
+processed_by: vida
+processed_date: 2026-03-11
+claims_extracted: ["medicare-advantage-overpayments-total-1-2-trillion-over-2025-2034-driven-equally-by-coding-intensity-and-favorable-selection.md", "favorable-selection-in-medicare-advantage-is-structural-not-fraudulent-because-plan-design-features-discourage-high-utilizers.md"]
+enrichments_applied: ["value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md", "CMS 2027 chart review exclusion targets vertical integration profit arbitrage by removing upcoded diagnoses from MA risk scoring.md"]
+extraction_model: "anthropic/claude-sonnet-4.5"
+extraction_notes: "Extracted two claims: (1) the $1.2T overpayment total with equal split between coding and selection, and (2) the structural nature of favorable selection as a legal plan design feature rather than fraud. Enriched two existing claims with fiscal scale data. The favorable selection mechanism is the less-discussed half of the overpayment equation and deserved standalone claim treatment per curator notes. Connection to proxy inertia: MA plans rationally optimize current payment structure rather than pursue value-based care that would eliminate their selection advantage."
 ---
 
 ## Content
@@ -50,3 +56,13 @@ tags: [medicare-advantage, overpayment, fiscal-impact, coding-intensity, favorab
 PRIMARY CONNECTION: [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]]
 WHY ARCHIVED: Quantifies the fiscal stakes of MA reform — connects insurance market structure to Medicare solvency timeline.
 EXTRACTION HINT: The favorable selection mechanism deserves its own claim — it's the less-discussed half of the overpayment equation.
+
+
+## Key Facts
+- MA overpayments total $1.2 trillion over 2025-2034 (MedPAC data)
+- Coding intensity: $600B total ($260B Trust Fund, $110B beneficiary premiums)
+- Favorable selection: $580B total ($250B Trust Fund, $110B beneficiary premiums)
+- MA plans see 10% net payment increase from coding after CMS 5.9% adjustment
+- Favorable selection causes 11% increased MA costs vs FFS in 2025
+- CBO estimates reducing benchmarks could save $489B
+- Raising coding adjustment from 5.9% to 20% could save $1T+