CMS announces ‘significant expansion’ of Medicare Advantage audits

The Centers for Medicare and Medicaid Services announced a “significant expansion” of its auditing efforts for Medicare Advantage plans. “Beginning immediately, CMS will audit all eligible MA contracts for each payment year in all newly initiated audits and invest additional resources to expedite the completion of audits for payment years 2018 through 2024,” the agency said in a statement. Medicare Advantage plans receive risk-adjusted payments based on the diagnoses they submit for enrollees. To verify the accuracy of these claims, CMS conducts Risk Adjustment Data Validation audits to confirm that diagnoses used for payment are supported by medical records. Currently, CMS is several years behind in completing these audits, the agency noted. “To address this backlog,” the Trump Administration has introduced a plan to complete all remaining audits for 2018 to 2024 by early 2026. Publicly traded companies in the healthcare space include CVS Health (CVS), Centene (CNC), Cigna (CI), Elevance Health (ELV), Humana (HUM), Molina Healthcare (MOH) and UnitedHealth (UNH).