News Briefs: CMS to Ramp Up Medicare Advantage Audits

May 23
May 23, 2025

CMS on May 21 unveiled a “significant expansion” of its Medicare Advantage auditing efforts. The agency said it will audit all eligible MA contracts for each payment year in all newly initiated Risk Adjustment Data Validation (RADV) audits, and it will invest additional resources to expedite the completion of audits for payment years 2018 through 2024. CMS noted that it is several years behind in completing these RADV audits, as the last significant recovery of MA overpayments occurred following the audit of payment year 2007, “despite federal estimates suggesting MA plans may overbill the government by approximately $17 billion annually.” CMS uses RADV audits to ensure that diagnose codes submitted by MA plans for risk adjustment payment purposes are supported by medical records.
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Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.