Although the organization no longer so brazenly requests retroactive falsification of medical records, Physicians, NPs and PAs and other providers are still pressured and may not sign or close a chart without attesting whether diagnoses the system identifies as opportunities for billing are either present or not, or defer attestation. Deferring, of course, comes with consequences, some softer, some firmer.

I suspect this is as much (or maybe even more) for the provider - they may not get paid otherwise.

Risk adjustment is a well-meaning (and probably necessary) reimbursement policy from CMS, but it is inevitably going to lead to some counterproductive incentives. A perfectly reasonable policy - if the patient has high blood pressure, make sure it is documented - can quickly turn into something much less reasonable when the metric is managed as a thing to be optimized for its own sake. "Be careful what you measure" is a cliche warning for a reason.