CMS expanding its efforts to audit MA plans

The Centers for Medicare and Medicaid Services (CMS) announced it is expanding its efforts to audit Medicare Advantage (MA) plans risk adjustment payments through the Risk Adjustment Data Validation (RADV) program. A risk adjustment factor (RAF) is calculated for each member based on individual attributes that contribute to costs of care, including age, sex, health conditions, and socioeconomic status. CMS uses risk adjustment to determine monthly capitation payments to Medicare Advantage plans. The reports have shown that CMS has overpaid Medicare Advantage plans by $75 billion in 2023. The Committee for Responsible Federal Budget published a blog on how CMS is taking steps to recover overpayments from Medicare Advantage plans. Read their blog here…

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