This episode explains how Medicare Advantage shifted from care delivery to score optimization. Star Ratings were introduced as simple transparency tools, similar to reviews, not outcome measures. When money was tied to them under the ACA, they became economic levers. Combined with Risk Adjustment, they turned sickness into revenue and documentation into strategy. Plans built vendor ecosystems to optimize metrics, not medicine. What began as quality measurement became performance theater, market consolidation, and a system vulnerable to fraud, waste, and abuse. This is the moment Medicare Advantage stops being healthcare infrastructure and becomes a scoring economy.