Case StudiesRedefining Readiness: Turning Medicare Advantage Audit Pressure into Performance – White Paper
On May 21, 2025, Centers for Medicare & Medicaid Services (CMS) announced it will begin conducting Risk Adjustment Data Validation (RADV) audits annually across all 500+ Medicare Advantage (MA) plans, a move aimed at recouping overpayments and addressing delayed oversight. While RADV audits focus on validating diagnosis codes tied to plan payments, they may signal broader regulatory scrutiny ahead.