Managed Healthcare Executive June 30, 2025
To prepare for CMS’ new risk adjustment data validation (RADV) strategy, Medicare Advantage plans must take a coordinated, organization-wide approach.
On May 21, 2025, the Centers for Medicare and Medicaid Services (CMS) announced their plan to accelerate and expand risk adjustment data validation (RADV) audits. CMS has stated that Medicare Advantage (MA) plans may overbill the government by approximately $17 billion annually. The most recently reported net MA Payment Error Rate from FY 2024 was $15.34 billion.
Today the payment year 2018 RADV audit is currently in progress and RADV audits for payment years 2019–2024 have not yet begun. In its announcement, CMS stated its plan to clear the backlog of RADV audits for prior payment years by early 2026....
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